They found that overall patient age distribution was remarkably similar between the two countries, although the U.S. had proportionally more admissions over the age of 85 (7.8 percent versus 3.2 percent.)
However, the degree of illness of the patients prior to admission was strikingly different. Patients admitted to the ICU in the U.K. were sicker patients who had been in the hospital longer. Also, many more of the patients admitted in the U.K. were mechanically ventilated.
In contrast, U.S. patients were more likely to be admitted to the ICU straight from the emergency room compared to U.K. patients, indicating that fewer ICU beds in the U.K. may necessitate patients spending more time in the general wards than in the U.S.
Dr. Wunsch and colleagues found that hospital mortality for ICU patients was substantially higher in the U.K. than in the U.S., even after accounting for severity of illness, probably because of "a combination of many unmeasured differences in both patients and healthcare systems," said Dr. Wunsch. However, when Dr. Wunsch and colleagues compared subgroups of similarly ill patientsthose who were admitted directly from the emergency room and who had been mechanically ventilated in the first 24 hours after admissionthe mortality rates were similar.
"These findings highlight the importance of comparing 'like with like', and how hard that can be when looking at heterogeneous patients cared for in different healthcare systems," said Dr. Wunsch.
Comparing hospital mortality between the countries was also confounded by the trend for U.S. ICUs to discharge patients to "skilled care facilities" rather than directly home, as was the case in the U.K.
"The U.S. and the U.K. have very different discharge patterns, and the trend in the U.S. has been to shorten hospital length of stay and discharge people earlier to other types of facilities." said Dr. Wunsch. "If you look at hospital length-of-sta
|Contact: Keely Savoie|
American Thoracic Society