Background There are few studies on intensive care unit (ICU) patients in the Republic of Korea. We analyzed the characteristics and mortality changes of all ICU patients over the last 8 years.
Methods This study used the cohort of the National Health Insurance Corporation, which provides medical care to all residents of the Republic of Korea. The cohort consists of patients aged 20 years or older between 2003 and 2010 with a history of ICU admission. We analyzed changes in sex, age, household income, number of hospital beds, emergency admissions, and reasons for admission using the Cochran–Armitage trend test. The adjusted hazard ratios (HRs) of mortality according to these variables and year of admission were calculated by Cox proportional hazards regression.
Results The proportion of patients aged ≥70 years increased over that period, as did their average age (by 3.6 years). During the 8-year study period, the 3-year mortality rate was 32.91%–35.83%. The overall mortality was higher in males and older patients, in those with a lower household income and higher Charlson Comorbidity Index (CCI) score, those admitted to a hospital with a smaller number of beds, and those admitted via the emergency room. There was no significant change in crude mortality rate over the 8-year study period; however, the adjusted HR showed a decreasing trend.
Conclusions Patients admitted to the ICU were older and had higher CCI score. Nevertheless, there was a temporal trend toward a decrease in the HR of long-term mortality.
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BACKGROUND Early defibrillation is the treatment of choice in out-of-hospital cardiac arrests (OHCA) with initial shockable rhythms. However, the relationship between the frequency of defibrillation and neurological outcome was not clear. In this study, the frequency of defibrillation and other factors related to neurological outcome were investigated. METHODS Records of 255 adult patients, who were admitted to the hospital after resuscitation from OHCA between November 2008 and March 2012, were retrospectively reviewed. 6 months after the return of spontaneous circulation, patients were divided into two groups based on the cerebral performance category (CPC) score for neurologic prognosis. The frequency of defibrillation during resuscitation and other variables were analyzed between the two groups. RESULTS In the study group, initial rhythm was divided into two groups, non shockable rhythm (200, 78.4%) and shockable rhythm (55, 21.6%). The frequency of 1-7 defibrillations was significantly associated with good neurological outcome (OR 3.05, 95% CI 1.328-6.850). In addition, shockable initial rhythm (OR 4.520, 95% CI 1.953-10.459), arrest caused cardiac origin (OR 2.945, 95% CI 1.334-6.500), time to BLS (OR 1.139, 95% CI 1.033-1.256) and lower APACHII score (OR 1.095, 95% CI 1.026-1.169), which were associated with good neurological outcomes, independently. CONCLUSIONS In those patients who survived from OHCA, adequate defibrillation was important to improve the neurological outcome, whether the initial rhythm was shockable or not. Frequency of 1-7 times defibrillation was associated with good neurological outcome.
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