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Journal of critical care · Apr 2024
Meta AnalysisAdverse events leading to intensive care unit admission in a low-and-middle-income-country: A prospective cohort study and a systematic review.
- Rodolpho Augusto de Moura Pedro, BesenBruno Adler Maccagnan PinheiroBAMPIntensive Care Unit, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil., Pedro Vitale Mendes, Augusto ... more
- Intensive Care Unit, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil. Electronic address: rodolphopedro@hc.fm.usp.br.
- J Crit Care. 2024 Apr 1; 80: 154510154510.
IntroductionAdverse events (AE) are frequent in critical care and could be even more prevalent in LMIC due to a shortage of ICU beds and Human resources. There is limited data on how relevant AE are among the reasons for ICU admission, being all of which published by High-Income-Countries services. Our main goal is to describe the rate of adverse events-related ICU admissions and their preventability in a LMIC scenario, comparing our results with previous data.MethodsThis was a prospective cohort study, during a one-year period, in two general ICUs from a tertiary public academic hospital. Our exposure of interest was ICU admission related to an AE in adult patients, we further characterized their preventability and clinical outcomes. We also performed a systematic review to identify and compare previous published data on ICU admissions due to AE.ResultsAmong all ICU admissions, 12.1% were related to an AE (9.8% caused by an AE, 2.3% related but not directly caused by an AE). These ICU admissions were not associated with a higher risk of death, but most of them were potentially preventable (70.9% of preventability rate, representing 8.6% of all ICU admissions). The meta-analysis resulted in a proportion of ICU admissions due to AE of 11% (95% CI 6%-16%), with a preventability rate of 54% (95% CI 42%-66%).ConclusionsIn this prospective cohort, adverse events were a relevant reason for ICU admission. This result is consistent with data retrieved from non-LMIC as shown in our meta-analysis. The high preventability rate described reinforces that quality and safety programs could work as a tool to optimize scarce resources.Copyright © 2023. Published by Elsevier Inc.
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