Delayed Admission to the Intensive Care Unit and Mortality of Critically Ill Adults: Systematic Review and Meta‐analysis
Open accessAbstract
Delayed admission of patients to the intensive care unit (ICU) is increasing worldwide and can be followed by adverse outcomes when critical care treatment is not provided timely. This systematic review and meta‐analysis appraised and synthesized the published literature about the association between delayed ICU admission and mortality of adult patients. Articles published from inception up to August 2021 in English‐language, peer‐reviewed journals indexed in CINAHL, PubMed, Scopus, Cochrane Library, and Web of Science were searched by using key terms. Delayed ICU admission constituted the intervention, while mortality for any predefined time period was the outcome. Risk for bias was evaluated with the Newcastle‐Ottawa Scale and additional criteria. Study findings were synthesized qualitatively, while the odds ratios (ORs) for mortality with 95% confidence intervals (CIs) were combined quantitatively. Thirty‐four observational studies met inclusion criteria. Risk for bias was low in most studies. Unadjusted mortality was reported in 33 studies and was significantly higher in the delayed ICU admission group in 23 studies. Adjusted mortality was reported in 18 studies, and delayed ICU admission was independently associated with significantly higher mortality in 13 studies. Overall, pooled OR for mortality in case of delayed ICU admission was 1.61 (95% CI 1.44‐1.81). Interstudy heterogeneity was high ( I 2 = 66.96 % ). According to subgroup analysis, OR for mortality was remarkably higher in postoperative patients (OR, 2.44, 95% CI 1.49‐4.01). These findings indicate that delayed ICU admission is significantly associated with mortality of critically ill adults and highlight the importance of providing timely critical care in non‐ICU settings.
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Early ICU transfer is a window of critical opportunity for timely clinical interventions that alter the trajectory of a patient's clinical progression, prevent adverse outcomes and improve survival.
“Early ICU transfer has been shown to be a ‘window of critical opportunity’ for timely clinical interventions that alter the trajectory of a patient’s clinical progression, prevent adverse outcomes and improve survival35–39.”
From Real-time surveillance system for patient deterioration: a pragmatic cluster-randomized controlled trial (2025) · cites this paper as [35]
The Results (section 3.6; page unavailable) report that delayed ICU admission was associated with higher mortality, supporting the survival-related part of the claim. But the paper does not show that early transfer itself enables interventions that change a patient’s trajectory or prevent adverse outcomes. The Discussion (section 4.3; page unavailable) says timely critical care should not depend on ICU admission. (LLM, conf=0.86)
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- Authors
- Kiekkas, P., Tzenalis, A., Gklava, V., Stefanopoulos, N., Voyagis, G., & Aretha, D.
- Affiliations
- University of Patras (GR)
- General University Hospital of Patras (GR)
- Venue
- BioMed Research International
- Publisher
- Wiley
- Published
- 2022-01
- Volume
- 2022
- Issue
- 1
- Pages
- 4083494-4083494
- ISSN
- 1110-7243 (ISSN-L)
- 2314-6133
- 2314-6141
- PMC
- PMC8822318
- OpenAlex
- W4210862364
- Cited by
- 59
- References
- 56
- Citations by year
- 2026: 14 · 2025: 18 · 2024: 11 · 2023: 11 · 2022: 5
- FWCI
- 1.79
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- BioMed Research International (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
- Keywords
- delayed ICU admission, intensive care unit admission, mortality, critically ill adults, postoperative patients
- MeSH terms
- Adult, Humans, Intensive Care Units, Patient Admission, Time Factors, Critical Illness, Hospital Mortality
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