Is the benefit of a post-ICU follow-up service dependent on the risk of death pre-ICU discharge?

Introduction

The introduction of a post-ICU follow-up service has been shown to reduce post-ICU deaths [1]. However, follow-up may be less effective in patients at high risk of death at ICU discharge and would then lead to a selection of deaths with more risk factors after the introduction of a post-ICU follow-up service.

Methods

A retrospective database survey was performed. All deaths in the year before follow-up were compared with all deaths after a follow-up service was established. Known risk factors predicting post-ICU death were compared between both groups of deaths: age, sex, APACHE scores, LOD scores at discharge, source and type of admission and co-morbidity. Source of admission was classified as ward vs nonward and type of admission as acute surgical vs other. Co-morbidity was classified as present or absent according to the APACHE system classification of chronic illness. Differences between means of continuous variables were tested by Student t test. Differences between proportions were tested by the method as described by Armitage [2]. P < 0.05 was considered statistically significant.

Results

Twenty-seven deaths were identified in each period. A total of 16 complete datasets were available for analysis. There was a trend towards lower mortality after establishment of a follow-up service (8.76% vs 10.26%). Patients who died after establishment of a follow-up service had undergone significantly more acute surgery and showed a trend towards higher APACHE and LOD scores as well as a higher prevalence of co-morbidity.

Conclusion

The effectiveness of a post-ICU follow-up service may be less, the higher the risk of death pre-ICU discharge.

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