• Steven A Frost, Patricia M Davidson, Evan Alexandrou, Leanne Hunt, Yenna Salamonson, Victor Tam, Michael Ja Parr, Anders Aneman, and Ken M Hillman.
• Department of Intensive Care, Liverpool Hospital, Sydney, NSW. s.frost@uws.edu.au.
• Crit Care Resusc. 2010 Sep 1; 12 (3): 171-6.

BackgroundUnplanned admission to the intensive care unit has been shown to significantly increase the risk of inhospital mortality. Medical advances and increased expectations have resulted in a greater number of very elderly patients (80 years and over) being admitted to the ICU. The risk of in-hospital death associated with unplanned admission to the ICU in very elderly patients has not been clearly defined.ObjectiveTo estimate the risk of in-hospital mortality associated with unplanned admission to the ICU in patients aged 80 years and over.Design, Setting And ParticipantsRetrospective review of an adult intensive care database. The setting was Liverpool Hospital, a large teaching hospital in Sydney, Australia, with a 28-bed ICU that has about 2000 admissions per year. We analysed data on very elderly patients (n = 1680), aged 80 years or more, admitted to the ICU between 1 January 1997 and 31 December 2007.Main Outcome MeasuresBaseline risk factors for inhospital mortality.ResultsMortality among patients with unplanned ICU admissions was 47%, compared with 25% in patients with planned admissions (adjusted rate ratio [RR], 1.92 [95% CI, 1.59-2.32]). An estimated 50% of the overall risk of inhospital death among very elderly patients was attributable to a combination of unplanned admission to the ICU, the presence of at least one comorbid condition, acute renal failure and respiratory failure requiring intubation.ConclusionUnplanned admission to the ICU increases the risk of in-hospital mortality in very elderly patients. At least 50% of the risk of in-hospital death in this age group is attributable to a combination of unplanned ICU admission, comorbidity (≥1 comorbid condition), acute renal failure and respiratory failure.

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