Lowell Ling1, Chun Ming Ho2, Pauline Yeung Ng3,4, King Chung Kenny Chan2, Hoi Ping Shum5, Cheuk Yan Chan5, Alwin Wai Tak Yeung6, Wai Tat Wong7, Shek Yin Au8, Kit Hung Anne Leung8, Jacky Ka Hing Chan9, Chi Keung Ching9, Oi Yan Tam10, Hin Hung Tsang10, Ting Liong11, Kin Ip Law11, Manimala Dharmangadan12,13, Dominic So12,13, Fu Loi Chow14, Wai Ming Chan4, Koon Ngai Lam15, Kai Man Chan16, Oi Fung Mok17, Man Yee To17, Sze Yuen Yau17, Carmen Chan17, Ella Lei17, Gavin Matthew Joynt7. 1. Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, Hong Kong, China. lowell.ling@cuhk.edu.hk. 2. Department of Anaesthesia and Intensive Care, Tuen Mun Hospital, Hong Kong, China. 3. Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. 4. Department of Adult Intensive Care, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China. 5. Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China. 6. Department of Medicine & Geriatrics, Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong, China. 7. Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, Hong Kong, China. 8. Department of Intensive Care, Queen Elizabeth Hospital, Hong Kong, China. 9. Department of Medicine, Tseung Kwan O Hospital, Hong Kong, China. 10. Department of Intensive Care, Kwong Wah Hospital, Hong Kong, China. 11. Department of Intensive Care, United Christian Hospital, Hong Kong, China. 12. Department of Intensive Care, Princess Margaret Hospital, Hong Kong, China. 13. Department of Intensive Care, Yan Chai Hospital, Hong Kong, China. 14. Department of Intensive Care, Caritas Medical Centre, Hong Kong, China. 15. Department of Intensive Care, North District Hospital, Hong Kong, China. 16. Intensive Care Unit, Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China. 17. Quality and Safety Division, Hospital Authority Head Office, Hong Kong, China.
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.
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 illpatients in Hong Kong.
Entities:
Keywords:
APACHE IV; Benchmarking; Hong Kong; Intensive care; Standard mortality ratio
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