A prolonged ICU stay after interhospital transport?

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Abstract

Transport of critically ill patients can be complicated
[1-3]. Barratt and colleagues studied patients transferred
for nonclinical reasons to evaluate the consequences of
transportation [4]. Th ere was no diff erence in mortality
but the ICU length of stay (LOS) increased by 3  days,
which was explained as a negative impact of the transport
on patient physiology. We disagree with this conclusion.
First, by including only transports to level 3 ICUs the
received level of care for transported patients will
increase, introducing a bias.
Second, the increase in LOS can be interpreted as a
result of selection bias, because patients with a short
expected LOS would often not be considered eligible for
transport. Also, since there was no increase in mortality,
which would have been expected with an increased LOS,
we might be looking at a mortality reduction as a result
of the transfer to a higher-level ICU.
Th ird, Barrett and colleagues suggest that deterioration
of patient physiology during transport is probably respon
sible for the increase in LOS. However, the reported
Intensive Care National Audit and Research Centre
scores before and after transport (although not validated
for sequential patient assessments) do not support this
assumption.
Fourth, the method of transportation should have been
included in this study. Specialised transport teams deliver
patients with a better acute physiology compared with
nonspecialised teams [2,5], making a need for regaining
physiological stability unlikely.
In conclusion, we congratulate Barratt and colleagues
for their research. However, we think their conclusion is
premature because multiple possible confounders were
not taken into account.
Original languageEnglish
Article number465
Number of pages1
JournalCritical Care
Volume16
Issue number6
DOIs
Publication statusPublished - 23-Nov-2012

Keywords

  • Critical Illness/mortality
  • Female
  • Hospitalization/trends
  • Humans
  • Intensive Care Units/trends
  • Male
  • Patient Transfer/trends
  • Propensity Score

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