Pölkki, Anssi; Moser, André; Raj, Rahul; Takala, Jukka; Bendel, Stepani; Jakob, Stephan M; Reinikainen, Matti (2024). The Influence of Potential Organ Donors on Standardized Mortality Ratios and ICU Benchmarking. Critical care medicine, 52(3), pp. 387-395. Lippincott Williams & Wilkins 10.1097/CCM.0000000000006098
|
Text
the_influence_of_potential_organ_donors_on.234.pdf - Published Version Available under License Creative Commons: Attribution-Noncommercial-No Derivative Works (CC-BY-NC-ND). Download (1MB) | Preview |
OBJECTIVES
The standardized mortality ratio (SMR) is a common metric to benchmark ICUs. However, SMR may be artificially distorted by the admission of potential organ donors (POD), who have nearly 100% mortality, although risk prediction models may not identify them as high-risk patients. We aimed to evaluate the impact of PODs on SMR.
DESIGN
Retrospective registry-based multicenter study.
SETTING
Twenty ICUs in Finland, Estonia, and Switzerland in 2015-2017.
PATIENTS
Sixty thousand forty-seven ICU patients.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
We used a previously validated mortality risk model to calculate the SMRs. We investigated the impact of PODs on the overall SMR, individual ICU SMR and ICU benchmarking. Of the 60,047 patients admitted to the ICUs, 514 (0.9%) were PODs, and 477 (93%) of them died. POD deaths accounted for 7% of the total 6738 in-hospital deaths. POD admission rates varied from 0.5 to 18.3 per 1000 admissions across ICUs. The risk prediction model predicted a 39% in-hospital mortality for PODs, but the observed mortality was 93%. The ratio of the SMR of the cohort without PODs to the SMR of the cohort with PODs was 0.96 (95% CI, 0.93-0.99). Benchmarking results changed in 70% of ICUs after excluding PODs.
CONCLUSIONS
Despite their relatively small overall number, PODs make up a large proportion of ICU patients who die. PODs cause bias in SMRs and in ICU benchmarking. We suggest excluding PODs when benchmarking ICUs with SMR.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care 04 Faculty of Medicine > Pre-clinic Human Medicine > Department of Clinical Research (DCR) |
UniBE Contributor: |
Moser, André, Takala, Jukka, Jakob, Stephan |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
0090-3493 |
Publisher: |
Lippincott Williams & Wilkins |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
14 Nov 2023 10:50 |
Last Modified: |
22 Feb 2024 00:13 |
Publisher DOI: |
10.1097/CCM.0000000000006098 |
PubMed ID: |
37947476 |
Additional Information: |
Pölkki and Moser contributed equally to this work (shared first authorship). |
BORIS DOI: |
10.48350/188790 |
URI: |
https://boris.unibe.ch/id/eprint/188790 |
Actions (login required)
 |
Edit item |