Cited by 420Sepsis Diagnosis and TreatmentGlobal Health and EpidemiologyNosocomial Infections in ICU

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The Epidemiology of Chronic Critical Illness in the United States*

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Kahn, Jeremy M., Le, Tri, Angus, Derek C., Cox, Christopher E., Hough, Catherine L., White, Douglas B., Yende, Sachin, Carson, Shannon S.·2015·Critical Care Medicine

DOI 10.1097/ccm.0000000000000710PMC PMC7901538

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Abstract

OBJECTIVES: The epidemiology of chronic critical illness is not well characterized. We sought to determine the prevalence, outcomes, and associated costs of chronic critical illness in the United States. DESIGN: Population-based cohort study using data from the United States Healthcare Costs and Utilization Project from 2004 to 2009. SETTING: Acute care hospitals in Massachusetts, North Carolina, Nebraska, New York, and Washington. PATIENTS: Adult and pediatric patients meeting a consensus-derived definition for chronic critical illness, which included one of six eligible clinical conditions (prolonged acute mechanical ventilation, tracheotomy, stroke, traumatic brain injury, sepsis, or severe wounds) plus at least 8 days in an ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Out of 3,235,741 admissions to an ICU during the study period, 246,151 (7.6%) met the consensus definition for chronic critical illness. The most common eligibility conditions were prolonged acute mechanical ventilation (72.0% of eligible admissions) and sepsis (63.7% of eligible admissions). Among patients meeting chronic critical illness criteria through sepsis, the infections were community acquired in 48.5% and hospital acquired in 51.5%. In-hospital mortality was 30.9% with little change over the study period. The overall population-based prevalence was 34.4 per 100,000. The prevalence varied substantially with age, peaking at 82.1 per 100,000 individuals 75-79 years old but then declining coincident with a rise in mortality before day 8 in otherwise eligible patients. Extrapolating to the entire United States, for 2009, we estimated a total of 380,001 cases; 107,880 in-hospital deaths and $26 billion in hospital-related costs. CONCLUSIONS: Using a consensus-based definition, the prevalence, hospital mortality, and costs of chronic critical illness are substantial. Chronic critical illness is particularly common in the elderly although in very old patients the prevalence declines, in part because of an increase in early mortality among potentially eligible patients.

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Self-citation

Authors: Kahn, J. M., Le, T., Angus, D. C., Cox, C. E., Hough, C. L., White, D. B., Yende, S., & Carson, S. S.
Affiliations: University of North Carolina at Chapel Hill (US)
University of Pittsburgh (US)
Duke University (US)
University of Washington (US)
ORCID: Kahn, Jeremy M.
Angus, Derek C.
Cox, Christopher E.
Hough, Catherine L.
White, Douglas B.
Yende, Sachin
Carson, Shannon S.
Venue: Critical Care Medicine
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2015-02
Volume: 43
Issue: 2
Pages: 282-287
ISSN: 0090-3493 (ISSN-L)
DOI: 10.1097/ccm.0000000000000710
PMC: PMC7901538
OpenAlex: W2063094401
Cited by: 420
References: 32
Citations by year: 2026: 33 · 2025: 33 · 2024: 38 · 2023: 40 · 2022: 42 · 2021: 45 · 2020: 39 · 2019: 42 · 2018: 21 · 2017: 36 · 2016: 30 · 2015: 21
FWCI: 21.91
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Critical Care Medicine (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Heart, Lung, and Blood Institute (R01HL096651)
Topics: Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Sepsis Diagnosis and Treatment
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health and Epidemiology
Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
Keywords: chronic critical illness, prolonged mechanical ventilation, sepsis, intensive care unit admission, prevalence, in-hospital mortality, health care costs, community-acquired infections, nosocomial infections, elderly patients, pediatric patients, acute respiratory failure, traumatic brain injury, stroke
MeSH terms: Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Chronic Disease, Costs and Cost Analysis, Cross Infection, Female, Hospital Bed Capacity, Humans, Infant, Intensive Care Units, Length of Stay, Long-Term Care, Male, Middle Aged, Respiration, Artificial, United States, Prevalence, Critical Illness, Treatment Outcome, Hospital Mortality, Age Distribution, Sex Distribution, Community-Acquired Infections, Sepsis, Young Adult

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