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Open Access Highly Accessed Research

Changes in hospital mortality for United States intensive care unit admissions from 1988 to 2012

Jack E Zimmerman1, Andrew A Kramer2* and William A Knaus3

Author Affiliations

1 Department of Anesthesiology and Critical Care Medicine, George Washington University, 17612 Coatbridge Place, Olney, MD, 20832, USA

2 Cerner Corporation, 1953 Gallows Rd., Suite 500, Vienna, VA, 22182, USA

3 Center for Clinical and Research Informatics, North Shore Research Institute, 1001 University Place, Evanston, IL, 60201, USA

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Critical Care 2013, 17:R81  doi:10.1186/cc12695

Published: 27 April 2013

Abstract

Introduction

A decrease in disease-specific mortality over the last twenty years has been reported for patients admitted to United States (US) hospitals, but data for intensive care patients are lacking. The aim of this study was to describe changes in hospital mortality and case-mix using clinical data for patients admitted to multiple US ICUs over the last 24 years.

Methods

We carried out a retrospective time series analysis of hospital mortality using clinical data collected from 1988 to 2012. We also examined the impact of ICU admission diagnosis and other clinical characteristics on mortality over time. The potential impact of hospital discharge destination on mortality was also assessed using data from 2001 to 2012.

Results

For 482,601 ICU admissions there was a 35% relative decrease in mortality from 1988 to 2012 despite an increase in age and severity of illness. This decrease varied greatly by diagnosis. Mortality fell by

    >
60% for patients with chronic obstructive pulmonary disease, seizures and surgery for aortic dissection and subarachnoid hemorrhage. Mortality fell by 51% to 59% for six diagnoses, 41% to 50% for seven diagnoses, and 10% to 40% for seven diagnoses. The decrease in mortality from 2001 to 2012 was accompanied by an increase in discharge to post-acute care facilities and a decrease in discharge to home.

Conclusions

Hospital mortality for patients admitted to US ICUs has decreased significantly over the past two decades despite an increase in the severity of illness. Decreases in mortality were diagnosis specific and appear attributable to improvements in the quality of care, but changes in discharge destination and other confounders may also be responsible.

Keywords:
intensive care unit; hospital mortality; time trends; post-acute care; patient discharge; severity of illness