Critical care medicine
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Critical care medicine · Mar 1986
Dynamic assessment of severity of illness in pediatric intensive care.
Severity of illness in 293 pediatric ICU patients was assessed by a daily estimate of ICU survival. The probability of nonsurvival was obtained by logistic regression analysis, using physiologic stability index (PSI) values from previous days as time-dependent covariates. Only PSI values from the previous 2 days gave statistically significant predictions of short-term (less than 24 h) outcome. ⋯ These results indicate that this model for daily risk assessment is statistically reliable and objective, as verified against eventual outcome. In the 345 patients, ICU mortality was predicted with 89% sensitivity and 91% specificity. This prediction model may be used to stratify patient groups for clinical studies, or identify very low-risk patients for potential early ICU discharge.
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Critical care medicine · Mar 1986
Prolonged mechanical ventilation of infants after open heart surgery.
Records of 140 infants younger than 2 yr of age who had undergone open heart surgery were studied to evaluate the duration of postoperative mechanical ventilation (MV), to determine the relationship between prolonged MV and mortality, and to identify variables predisposing the patient to prolonged MV. MV was required beyond the first postoperative day in 56 infants, and was prolonged for at least 7 days in 19 infants. Mortality was approximately the same (16% to 17%) whether or not MV was required for more than 7 days. ⋯ Multiple predisposing factors increased the probability of prolonged MV. Postoperative variables including premature extubation and a second surgical procedure also were associated with prolonged MV. The consequences of prolonged MV may be minimized by early nutritional support, aggressive surveillance for treatable complications, and avoidance of premature extubation.
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Critical care medicine · Mar 1986
Comparative StudyImpact of prospective payments on a tertiary care center receiving large numbers of critically ill patients by aeromedical transport.
To determine the economic impact of federal prospective payments and the potential effect if private insurance payers were to implement similar prospective payments, we examined payments under Medicare diagnosis-related grouping (DRG) reimbursement policies for 105 Medicare and 357 non-Medicare patients admitted to a tertiary care center via air transport. Among the 105 Medicare patients, the average length of stay was 11.4 days and the mortality rate was 24%. Hospital charges exceeded DRG reimbursement for 74% of Medicare patients. ⋯ For the 357 non-Medicare patients, the average length of stay was 10.8 days, the mortality rate was 10%, and hospital charges exceeded Medicare DRG reimbursement for 78% of the patients. Implementation of DRG-like payments by non-Medicare insurers would create a hospital revenue loss of $2,493,048 ($6983 per patient). We conclude that unless current and planned prospective payment policies are modified, the use of aeromedical transport services to recruit large numbers of critically ill patients to tertiary care centers is economically prohibitive.