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Direct admission to the intensive care unit from the emergency department and mortality in critically ill hematology patients

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Abstract
Background: The aim of this study was to assess the benefit of direct ICU admission from the emergency department (ED) compared to admission from wards, in patients with hematological malignancies requiring critical care. Methods: Post hoc analysis derived from a prospective, multicenter cohort study of 1011 critically ill adult patients with hematologic malignancies admitted to 17 ICU in Belgium and France from January 2010 to May 2011. The variable of interest was a direct ICU admission from the ED and the outcome was in-hospital mortality. The association between the variable of interest and the outcome was assessed by multivariable logistic regression after multiple imputation of missing data. Several sensitivity analyses were performed: complete case analysis, propensity score matching and multivariable Cox proportional-hazards analysis of 90-day survival. Results: Direct ICU admission from the ED occurred in 266 (26.4%) cases, 84 of whom (31.6%) died in the hospital versus 311/742 (41.9%) in those who did not. After adjustment, direct ICU admission from the ED was associated with a decreased in-hospital mortality (adjusted OR: 0.63; 95% CI 0.45-0.88). This was confirmed in the complete cases analysis (adjusted OR: 0.64; 95% CI 0.45-0.92) as well as in terms of hazard of death within the 90 days after admission (adjusted HR: 0.77; 95% CI 0.60-0.99). By contrast, in the propensity score-matched sample of 402 patients, direct admission was not associated with in-hospital mortality (adjusted OR: 0.92; 95% CI 0.84-1.01). Conclusions: In this study, patients with hematological malignancies admitted to the ICU were more likely to be alive at hospital discharge if they were directly admitted from the ED rather than from the wards. Assessment of early predictors of poor outcome in cancer patients admitted to the ED is crucial so as to allow early referral to the ICU and avoid delays in treatment initiation and mis-orientation.
Keywords
Emergency department, Direct admission, Intensive care unit, Hematological malignancy, CANCER-PATIENTS, SEVERE SEPSIS, OUTCOMES, EPIDEMIOLOGY, IMPACT, TIME

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MLA
Peyrony, Olivier, et al. “Direct Admission to the Intensive Care Unit from the Emergency Department and Mortality in Critically Ill Hematology Patients.” ANNALS OF INTENSIVE CARE, vol. 9, no. 1, 2019.
APA
Peyrony, O., Chevret, S., Meert, A.-P., Perez, P., Kouatchet, A., Pène, F., … Azoulay, E. (2019). Direct admission to the intensive care unit from the emergency department and mortality in critically ill hematology patients. ANNALS OF INTENSIVE CARE, 9(1).
Chicago author-date
Peyrony, Olivier, Sylvie Chevret, Anne-Pascale Meert, Pierre Perez, Achille Kouatchet, Frédéric Pène, Djamel Mokart, et al. 2019. “Direct Admission to the Intensive Care Unit from the Emergency Department and Mortality in Critically Ill Hematology Patients.” ANNALS OF INTENSIVE CARE 9 (1).
Chicago author-date (all authors)
Peyrony, Olivier, Sylvie Chevret, Anne-Pascale Meert, Pierre Perez, Achille Kouatchet, Frédéric Pène, Djamel Mokart, Virginie Lemiale, Alexandre Demoule, Martine Nyunga, Fabrice Bruneel, Christine Lebert, Dominique Benoit, Adrien Mirouse, and Elie Azoulay. 2019. “Direct Admission to the Intensive Care Unit from the Emergency Department and Mortality in Critically Ill Hematology Patients.” ANNALS OF INTENSIVE CARE 9 (1).
Vancouver
1.
Peyrony O, Chevret S, Meert A-P, Perez P, Kouatchet A, Pène F, et al. Direct admission to the intensive care unit from the emergency department and mortality in critically ill hematology patients. ANNALS OF INTENSIVE CARE. 2019;9(1).
IEEE
[1]
O. Peyrony et al., “Direct admission to the intensive care unit from the emergency department and mortality in critically ill hematology patients,” ANNALS OF INTENSIVE CARE, vol. 9, no. 1, 2019.
@article{8632396,
  abstract     = {Background: The aim of this study was to assess the benefit of direct ICU admission from the emergency department (ED) compared to admission from wards, in patients with hematological malignancies requiring critical care. 
Methods: Post hoc analysis derived from a prospective, multicenter cohort study of 1011 critically ill adult patients with hematologic malignancies admitted to 17 ICU in Belgium and France from January 2010 to May 2011. The variable of interest was a direct ICU admission from the ED and the outcome was in-hospital mortality. The association between the variable of interest and the outcome was assessed by multivariable logistic regression after multiple imputation of missing data. Several sensitivity analyses were performed: complete case analysis, propensity score matching and multivariable Cox proportional-hazards analysis of 90-day survival. 
Results: Direct ICU admission from the ED occurred in 266 (26.4%) cases, 84 of whom (31.6%) died in the hospital versus 311/742 (41.9%) in those who did not. After adjustment, direct ICU admission from the ED was associated with a decreased in-hospital mortality (adjusted OR: 0.63; 95% CI 0.45-0.88). This was confirmed in the complete cases analysis (adjusted OR: 0.64; 95% CI 0.45-0.92) as well as in terms of hazard of death within the 90 days after admission (adjusted HR: 0.77; 95% CI 0.60-0.99). By contrast, in the propensity score-matched sample of 402 patients, direct admission was not associated with in-hospital mortality (adjusted OR: 0.92; 95% CI 0.84-1.01). 
Conclusions: In this study, patients with hematological malignancies admitted to the ICU were more likely to be alive at hospital discharge if they were directly admitted from the ED rather than from the wards. Assessment of early predictors of poor outcome in cancer patients admitted to the ED is crucial so as to allow early referral to the ICU and avoid delays in treatment initiation and mis-orientation.},
  articleno    = {110},
  author       = {Peyrony, Olivier and Chevret, Sylvie and Meert, Anne-Pascale and Perez, Pierre and Kouatchet, Achille and Pène, Frédéric and Mokart, Djamel and Lemiale, Virginie and Demoule, Alexandre and Nyunga, Martine and Bruneel, Fabrice and Lebert, Christine and Benoit, Dominique and Mirouse, Adrien and Azoulay, Elie},
  issn         = {2110-5820},
  journal      = {ANNALS OF INTENSIVE CARE},
  keywords     = {Emergency department,Direct admission,Intensive care unit,Hematological malignancy,CANCER-PATIENTS,SEVERE SEPSIS,OUTCOMES,EPIDEMIOLOGY,IMPACT,TIME},
  language     = {eng},
  number       = {1},
  pages        = {9},
  title        = {Direct admission to the intensive care unit from the emergency department and mortality in critically ill hematology patients},
  url          = {http://dx.doi.org/10.1186/s13613-019-0587-7},
  volume       = {9},
  year         = {2019},
}

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