Clinical Outcome and Costs in Different Patient Population in Intensive Care: a Multicentre Study
Pařízková R., Černý V., Dostál P., Vašátko L. 1 , Hora P. 2 , Herold I. 3 , Novák I. 2 Nalos D. 1
Klinika anesteziologie, resuscitace a intenzivní medicíny LF UK a FN, Hradec Králové, přednosta doc. MUDr. Vladimír Černý, PhD., FCCM, 1 Anesteziologicko-resuscitační oddělení, Masarykova nemocnice, Ústí nad Labem, primář MUDr. Daniel Nalos, 2 I. interní klinika – metabolická jednotka intenzivní péče Lékařská fakulta Univerzity Karlovy, Plzeň, Fakultní nemocnice, přednosta prof. MUDr. Karel Opatrný, CSc., 3 Anesteziologicko-resuscitační oddělení, Klaudiánova nemocnice, Mladá Boleslav, primář MUDr. Ivan Herold, CSc. |
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Summary:
Intensive care represents an especially costly part of health care, and significantly affects total cost of in-patient hospital facilities. The aim of the
study was to compare the amount of costs and selected clinical markers in different diagnosis related groups, to compare results and to establish the
characteristics of patient populations.
In the set of 1,368 patients, we prospectively followed APACHE II and SOFA scores, length of hospitalization, clinical outcome and costs.
The patients were divided according to the type of admission (primary, secondary within 24 hours and secondary after 24 hours) and according to
the principle diagnosis to the following groups: trauma (TR, n = 115), head-brain injury (KCP, n = 137), chronic obstructive pulmonary disease
(COPD, n = 86), post-CPR states (KPCR, n = 184), acute respiratory distress syndrome (ARDS, n = 76) and intoxications (INTOX, n = 425). APACHE
II and SOFA scores of the whole group were significantly higher in non-survivors compared to survivors (median, percentiles 25–75%): 31, 24–36
and 13 (10–15) resp. 22, 16–28 and 7, 4–9; P < 0.001. Mean mortality of the group was 18,8%, the highest mortality was in the group KPCR (28,8%),
the least in the group KCP (10,9%). The longest length of stay (median, percentiles 25–75%) was observed in ARDS patients (14, 8–21), the shortest
in the patients of INTOX group (3, 2–7).
The mean cost associated with one patient of the group was 205,309 CZK, median 79,346 (23,467–242,249); non-survivors showed a statistically
significant higher costs compared to survivors (median 92,929, percentiles 30,925–324,362 resp. 75,552; 21,649–233,583; P = 0.047). The costs of
the whole group correlated with the length of hospitalization, R = 0,679 (P < 0,001). Comparing the costs between separate subgroups, the highest
costs were observed in patients with ARDS, the least costly were intoxicated patients. The leading factor determining the costs in all patients was the
length of stay.
Key words:
intensive care – APACHE II score – SOFA score – costs
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