Characteristics and outcomes of patients admitted to adult intensive care units in Hong Kong: a population retrospective cohort study from 2008 to 2018
Abstract Background Globally, mortality rates of patients admitted to the intensive care unit (ICU) have decreased over the last two decades. However, evaluations of the temporal trends in the characteristics and outcomes of ICU patients in Asia are limited. The objective of this study was to descri...
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2021-01-01
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Online Access: | https://doi.org/10.1186/s40560-020-00513-9 |
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Article |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Lowell Ling Chun Ming Ho Pauline Yeung Ng King Chung Kenny Chan Hoi Ping Shum Cheuk Yan Chan Alwin Wai Tak Yeung Wai Tat Wong Shek Yin Au Kit Hung Anne Leung Jacky Ka Hing Chan Chi Keung Ching Oi Yan Tam Hin Hung Tsang Ting Liong Kin Ip Law Manimala Dharmangadan Dominic So Fu Loi Chow Wai Ming Chan Koon Ngai Lam Kai Man Chan Oi Fung Mok Man Yee To Sze Yuen Yau Carmen Chan Ella Lei Gavin Matthew Joynt |
spellingShingle |
Lowell Ling Chun Ming Ho Pauline Yeung Ng King Chung Kenny Chan Hoi Ping Shum Cheuk Yan Chan Alwin Wai Tak Yeung Wai Tat Wong Shek Yin Au Kit Hung Anne Leung Jacky Ka Hing Chan Chi Keung Ching Oi Yan Tam Hin Hung Tsang Ting Liong Kin Ip Law Manimala Dharmangadan Dominic So Fu Loi Chow Wai Ming Chan Koon Ngai Lam Kai Man Chan Oi Fung Mok Man Yee To Sze Yuen Yau Carmen Chan Ella Lei Gavin Matthew Joynt Characteristics and outcomes of patients admitted to adult intensive care units in Hong Kong: a population retrospective cohort study from 2008 to 2018 Journal of Intensive Care Intensive care APACHE IV Benchmarking Hong Kong Standard mortality ratio |
author_facet |
Lowell Ling Chun Ming Ho Pauline Yeung Ng King Chung Kenny Chan Hoi Ping Shum Cheuk Yan Chan Alwin Wai Tak Yeung Wai Tat Wong Shek Yin Au Kit Hung Anne Leung Jacky Ka Hing Chan Chi Keung Ching Oi Yan Tam Hin Hung Tsang Ting Liong Kin Ip Law Manimala Dharmangadan Dominic So Fu Loi Chow Wai Ming Chan Koon Ngai Lam Kai Man Chan Oi Fung Mok Man Yee To Sze Yuen Yau Carmen Chan Ella Lei Gavin Matthew Joynt |
author_sort |
Lowell Ling |
title |
Characteristics and outcomes of patients admitted to adult intensive care units in Hong Kong: a population retrospective cohort study from 2008 to 2018 |
title_short |
Characteristics and outcomes of patients admitted to adult intensive care units in Hong Kong: a population retrospective cohort study from 2008 to 2018 |
title_full |
Characteristics and outcomes of patients admitted to adult intensive care units in Hong Kong: a population retrospective cohort study from 2008 to 2018 |
title_fullStr |
Characteristics and outcomes of patients admitted to adult intensive care units in Hong Kong: a population retrospective cohort study from 2008 to 2018 |
title_full_unstemmed |
Characteristics and outcomes of patients admitted to adult intensive care units in Hong Kong: a population retrospective cohort study from 2008 to 2018 |
title_sort |
characteristics and outcomes of patients admitted to adult intensive care units in hong kong: a population retrospective cohort study from 2008 to 2018 |
publisher |
BMC |
series |
Journal of Intensive Care |
issn |
2052-0492 |
publishDate |
2021-01-01 |
description |
Abstract Background Globally, mortality rates of patients admitted to the intensive care unit (ICU) have decreased over the last two decades. However, evaluations of the temporal trends in the characteristics and outcomes of ICU patients in Asia are limited. The objective of this study was to describe the characteristics and risk adjusted outcomes of all patients admitted to publicly funded ICUs in Hong Kong over a 11-year period. The secondary objective was to validate the predictive performance of Acute Physiology And Chronic Health Evaluation (APACHE) IV for ICU patients in Hong Kong. Methods This was an 11-year population-based retrospective study of all patients admitted to adult general (mixed medical-surgical) intensive care units in Hong Kong public hospitals. ICU patients were identified from a population electronic health record database. Prospectively collected APACHE IV data and clinical outcomes were analysed. Results From 1 April 2008 to 31 March 2019, there were a total of 133,858 adult ICU admissions in Hong Kong public hospitals. During this time, annual ICU admissions increased from 11,267 to 14,068, whilst hospital mortality decreased from 19.7 to 14.3%. The APACHE IV standard mortality ratio (SMR) decreased from 0.81 to 0.65 during the same period. Linear regression demonstrated that APACHE IV SMR changed by − 0.15 (95% CI − 0.18 to − 0.11) per year (Pearson’s R = − 0.951, p < 0.001). Observed median ICU length of stay was shorter than that predicted by APACHE IV (1.98 vs. 4.77, p < 0.001). C-statistic for APACHE IV to predict hospital mortality was 0.889 (95% CI 0.887 to 0.891) whilst calibration was limited (Hosmer–Lemeshow test p < 0.001). Conclusions Despite relatively modest per capita health expenditure, and a small number of ICU beds per population, Hong Kong consistently provides a high-quality and efficient ICU service. Number of adult ICU admissions has increased, whilst adjusted mortality has decreased over the last decade. Although APACHE IV had good discrimination for hospital mortality, it overestimated hospital mortality of critically ill patients in Hong Kong. |
topic |
Intensive care APACHE IV Benchmarking Hong Kong Standard mortality ratio |
url |
https://doi.org/10.1186/s40560-020-00513-9 |
work_keys_str_mv |
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doaj-f3649074d30a49b9be47df79d097ee4b2021-01-10T12:14:55ZengBMCJournal of Intensive Care2052-04922021-01-019111010.1186/s40560-020-00513-9Characteristics and outcomes of patients admitted to adult intensive care units in Hong Kong: a population retrospective cohort study from 2008 to 2018Lowell Ling0Chun Ming Ho1Pauline Yeung Ng2King Chung Kenny Chan3Hoi Ping Shum4Cheuk Yan Chan5Alwin Wai Tak Yeung6Wai Tat Wong7Shek Yin Au8Kit Hung Anne Leung9Jacky Ka Hing Chan10Chi Keung Ching11Oi Yan Tam12Hin Hung Tsang13Ting Liong14Kin Ip Law15Manimala Dharmangadan16Dominic So17Fu Loi Chow18Wai Ming Chan19Koon Ngai Lam20Kai Man Chan21Oi Fung Mok22Man Yee To23Sze Yuen Yau24Carmen Chan25Ella Lei26Gavin Matthew Joynt27Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma Centre, Prince of Wales HospitalDepartment of Anaesthesia and Intensive Care, Tuen Mun HospitalDepartment of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong KongDepartment of Anaesthesia and Intensive Care, Tuen Mun HospitalDepartment of Intensive Care, Pamela Youde Nethersole Eastern HospitalDepartment of Intensive Care, Pamela Youde Nethersole Eastern HospitalDepartment of Medicine & Geriatrics, Ruttonjee and Tang Shiu Kin HospitalsDepartment of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma Centre, Prince of Wales HospitalDepartment of Intensive Care, Queen Elizabeth HospitalDepartment of Intensive Care, Queen Elizabeth HospitalDepartment of Medicine, Tseung Kwan O HospitalDepartment of Medicine, Tseung Kwan O HospitalDepartment of Intensive Care, Kwong Wah HospitalDepartment of Intensive Care, Kwong Wah HospitalDepartment of Intensive Care, United Christian HospitalDepartment of Intensive Care, United Christian HospitalDepartment of Intensive Care, Princess Margaret HospitalDepartment of Intensive Care, Princess Margaret HospitalDepartment of Intensive Care, Caritas Medical CentreDepartment of Adult Intensive Care, Queen Mary Hospital, The University of Hong KongDepartment of Intensive Care, North District HospitalIntensive Care Unit, Department of Medicine, Alice Ho Miu Ling Nethersole HospitalQuality and Safety Division, Hospital Authority Head OfficeQuality and Safety Division, Hospital Authority Head OfficeQuality and Safety Division, Hospital Authority Head OfficeQuality and Safety Division, Hospital Authority Head OfficeQuality and Safety Division, Hospital Authority Head OfficeDepartment of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma Centre, Prince of Wales HospitalAbstract Background Globally, mortality rates of patients admitted to the intensive care unit (ICU) have decreased over the last two decades. However, evaluations of the temporal trends in the characteristics and outcomes of ICU patients in Asia are limited. The objective of this study was to describe the characteristics and risk adjusted outcomes of all patients admitted to publicly funded ICUs in Hong Kong over a 11-year period. The secondary objective was to validate the predictive performance of Acute Physiology And Chronic Health Evaluation (APACHE) IV for ICU patients in Hong Kong. Methods This was an 11-year population-based retrospective study of all patients admitted to adult general (mixed medical-surgical) intensive care units in Hong Kong public hospitals. ICU patients were identified from a population electronic health record database. Prospectively collected APACHE IV data and clinical outcomes were analysed. Results From 1 April 2008 to 31 March 2019, there were a total of 133,858 adult ICU admissions in Hong Kong public hospitals. During this time, annual ICU admissions increased from 11,267 to 14,068, whilst hospital mortality decreased from 19.7 to 14.3%. The APACHE IV standard mortality ratio (SMR) decreased from 0.81 to 0.65 during the same period. Linear regression demonstrated that APACHE IV SMR changed by − 0.15 (95% CI − 0.18 to − 0.11) per year (Pearson’s R = − 0.951, p < 0.001). Observed median ICU length of stay was shorter than that predicted by APACHE IV (1.98 vs. 4.77, p < 0.001). C-statistic for APACHE IV to predict hospital mortality was 0.889 (95% CI 0.887 to 0.891) whilst calibration was limited (Hosmer–Lemeshow test p < 0.001). Conclusions Despite relatively modest per capita health expenditure, and a small number of ICU beds per population, Hong Kong consistently provides a high-quality and efficient ICU service. Number of adult ICU admissions has increased, whilst adjusted mortality has decreased over the last decade. Although APACHE IV had good discrimination for hospital mortality, it overestimated hospital mortality of critically ill patients in Hong Kong.https://doi.org/10.1186/s40560-020-00513-9Intensive careAPACHE IVBenchmarkingHong KongStandard mortality ratio |