Changes in hospital mortality for United States intensive care unit admissions from 1988 to 2012
Open accessAbstract
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.
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Demographic developments and an increasing number of comorbidities will lead to an ever-rising number of chronically ill patients in need of intensive care treatment.
“In decades to come, demographic developments and an increasing number of comorbidities will lead to an ever-rising number of chronically ill patients in need of intensive care treatment [1].”
From Clinical requirements of future patient monitoring in the intensive care unit: qualitative study (2019) · cites this paper as [1]
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- Authors
- Zimmerman, J. E., Kramer, A. A., & Knaus, W. A.
- Affiliations
- George Washington University (US)
- Corresponding author
- Kramer, Andrew A
- ORCID
- Kramer, Andrew A
- Venue
- Critical Care
- Published
- 2013-04-27
- Volume
- 17
- Issue
- 2
- Pages
- R81-R81
- ISSN
- 1364-8535 (ISSN-L)
- PMC
- PMC4057290
- OpenAlex
- W2124966164
- Cited by
- 533
- References
- 34
- Citations by year
- 2026: 38 · 2025: 45 · 2024: 52 · 2023: 51 · 2022: 40 · 2021: 52 · 2020: 48 · 2019: 51 · 2018: 49 · 2017: 33 · 2016: 42 · 2015: 16 · 2014: 14 · 2013: 1
- FWCI
- 17.73
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Critical Care (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Health Professions › Health Information Management › Global Health and Epidemiology
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Keywords
- ICU mortality, hospital mortality trends, case mix, chronic obstructive pulmonary disease, aortic dissection, subarachnoid hemorrhage, seizures, discharge disposition
- MeSH terms
- Female, Humans, Intensive Care Units, Male, Middle Aged, Patient Admission, Retrospective Studies, United States, Cohort Studies, Hospital Mortality
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