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Discretionary ICU admission for pneumonia improves survival rates

Discretionary admittance to the ICU improved 30-day mortality and resulted in comparable Medicare spending in hospital costs among older patients with pneumonia, compared with patients admitted to general wards, according to data recently published in JAMA.

“These findings suggest that ICU admission for borderline patients (those for whom ICU admission depends on the hospital to which they present) is associated with reduced mortality without a considerable increase in costs,” the researchers wrote.

To assess the correlation between ICU admission and outcome, 30-day mortality and costs in patients aged 65 years and older hospitalized for pneumonia, researchers conducted a retrospective cohort study of 1,112,394 Medicare beneficiaries with pneumonia admitted to acute care hospitals in the U.S. between 2010 and 2012.

Overall, 29.5% of participants were admitted to the ICU.

In unadjusted analyses, when compared with patients admitted to general wards, those admitted to an ICU had greater 30-day mortality (35.9% compared to 11.7% for general wards; absolute difference = 24.2%; 95% CI, 23.8%-24.6%), Medicare spending ($19,279 for ICU admission vs. $7,308 for general ward admission; absolute difference = $11,971; 95% CI, $11,634-$12,307) and hospital costs ($23,475 for ICU admission vs. $7,411 for general ward admission; absolute difference = $16,064; 95% CI, $15,658-$16,469).

An association was observed between distance from a hospital with high ICU admission and the rate of ICU admission: Participants living less than 3.3 miles from high-admission ICUs were more likely to be admitted compared with those living farther away (P < .001).

Thirteen percent of participants appeared to have discretionary admittance (dependent on distance) to an ICU. In an adjusted analysis, these patients had significantly lower 30-day mortality compared with patients admitted to general wards (P = .02). For these patients whose admittance depended on distance, no significant differences were seen in Medicare spending or hospital costs, according to the study.

The researchers noted that previous suggestions regarding reducing the supply of critical care beds to allow for cost savings and more efficient admissions may not be beneficial.

“The findings of this study conflict with such assertions and suggest that greater rates of ICU admissions for patients with pneumonia may not only improve survival, but might do so without significantly increasing hospital costs. Indeed, if replicated by others, these results could motivate a trial of increased access to ICU (or ICU-like) care for patients with pneumonia who might otherwise be cared for on the ward,” the researchers wrote. – by Casey Hower

Disclosures: The researchers report no relevant financial disclosures.