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      The Epidemiology of Chronic Critical Illness in the United States

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          Abstract

          Objective:

          The epidemiology of chronic critical illness is not well characterized. We sought to determine the incidence, outcomes and associated costs of chronic critical illness in the United States.

          Design:

          Population-based cohort study using data from the United States Healthcare Costs and Utilization Project from 2004 to 2009.

          Setting:

          Acute care hospitals in Massachusetts, North Carolina, Nebraska, New York and Washington.

          Patients:

          Adult and pediatric patients meeting a consensus-derived definition for chronic critical illness, which included one of 6 eligible clinical conditions (prolonged acute mechanical ventilation, tracheotomy, stroke, traumatic brain injury, sepsis or severe wounds) plus at least 8 days in an intensive care unit.

          Interventions:

          None.

          Measurements and Main Results:

          Out of 3,235,741 admissions to an intensive care unit during the study period, 246,151 (7.6%) met the consensus definition for chronic critical illness. The most common eligibility conditions were prolonged acute mechanical ventilation (72.0% of eligible admissions) and sepsis (63.7% of eligible admissions). Among patients meeting chronic critical illness criteria through sepsis, the infections were community-acquired in 48.5% and hospital acquired in 51.5%. In-hospital mortality was 30.9% with little change over the study period. The overall population-based incidence was 34.4 per 100,000. The incidence varied substantially with age, peaking at 82.1 per 100,000 individuals aged 75-79 but then declining coincident with a rise in mortality before day 8 in otherwise eligible patients. Extrapolating to the entire United States, for 2009 we estimated a total of 380,001 cases; 107,880 in-hospital deaths and $26 billion in hospital-related costs.

          Conclusions:

          Using a consensus-based definition, the incidence, hospital mortality and costs of chronic critical illness are substantial. Chronic critical illness is particularly common in the elderly, although in very old patients the incidence declines, in part due to an increase in early mortality among potentially eligible patients.

          Related collections

          Author and article information

          Journal
          0355501
          3206
          Crit Care Med
          Crit Care Med
          Critical care medicine
          0090-3493
          1530-0293
          11 February 2021
          February 2015
          23 February 2021
          : 43
          : 2
          : 282-287
          Affiliations
          [1. ]Clinical Research, Investigation and Systems Modeling of Acute Illness (CRISMA) Center; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
          [2. ]Department of Health Policy & Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
          [3. ]Division of Pulmonary, Allergy & Critical Care Medicine; Duke University School of Medicine, Durham, North Carolina
          [4. ]Division of Pulmonary & Critical Care Medicine; University of Washington School of Medicine, Seattle, Washington
          [5. ]Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina, Chapel Hill, North Carolina
          Author notes
          Contact: Jeremy M. Kahn, MD MS, Associate Professor of Critical Care and Health Policy & Management, University of Pittsburgh, Scaife Hall, Room 602-B, 3550 Terrace Street, Pittsburgh, PA 15261, phone: 412. kahnjm@ 123456upmc.edu
          Article
          PMC7901538 PMC7901538 7901538 nihpa1670211
          10.1097/CCM.0000000000000710
          7901538
          25377018
          51a9a67f-d4dd-47c6-8fd7-6a7543856165
          History
          Categories
          Article

          long-term care,sepsis,mechanical ventilation,intensive care units

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