RESUMO
BACKGROUND: An epidemiologic profile of traumatic brain injury (TBI) in Australia and New Zealand was obtained following the publication of international evidence-based guidelines. METHODS: Adult patients with TBI admitted to the intensive care units (ICU) of major trauma centers were studied in a 6-month prospective inception cohort study. Data including mechanisms of injury, prehospital interventions, secondary insults, operative and intensive care management, and outcome assessments 12-months postinjury were collected. RESULTS: There were 635 patients recruited from 16 centers. The mean (+/-SD) age was 41.6 years +/- 19.6 years; 74.2% were men; 61.4% were due to vehicular trauma, 24.9% were falls in elderly patients, and 57.2% had severe TBI (Glasgow Coma Scale score =8). Secondary brain insults were recorded in 28.5% and 34.8% underwent neurosurgical procedures before ICU admission. There was concordance with TBI and ICU practice guidelines, although intracranial pressure monitoring was used in 44.5% patients with severe TBI. Twelve-month mortality was 26.9% in all patients and 35.1% in patients with severe TBI. Favorable outcomes at 12 months were recorded in 58.8% of all patients and in 48.5% of patients with severe TBI. CONCLUSIONS: In Australia and New Zealand, mortality and favorable neurologic outcomes after TBI were similar to published data before the advent of evidence-based guidelines. A high incidence of prehospital secondary brain insults and an ageing population may have contributed to these outcomes. Strategies to improve outcomes from TBI should be directed at preventive public health strategies and interventions to minimize secondary brain injuries in the prehospital period.
Assuntos
Lesões Encefálicas/diagnóstico , Lesões Encefálicas/epidemiologia , Causas de Morte , Mortalidade Hospitalar/tendências , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Lesões Encefálicas/terapia , Estudos de Coortes , Terapia Combinada , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Escala de Coma de Glasgow , Humanos , Incidência , Escala de Gravidade do Ferimento , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Estudos Prospectivos , Medição de Risco , Distribuição por Sexo , Análise de Sobrevida , Fatores de Tempo , Centros de Traumatologia , Resultado do TratamentoRESUMO
BACKGROUND: There is limited information on changes in the epidemiology and outcome of patients with asthma admitted to intensive care units (ICUs) in the last decade. A database sampling intensive care activity in hospitals throughout Australia offers the opportunity to examine these changes. METHODS: The Australian and New Zealand Intensive Care Society Adult Patient Database was examined for all patients with asthma admitted to ICUs from 1996 to 2003. Demographic, physiological and outcome information was obtained and analysed from 22 hospitals which had submitted data continuously over this period. RESULTS: ICU admissions with the primary diagnosis of asthma represented 1899 (1.5%) of 126 906 admissions during the 8-year period. 36.1% received mechanical ventilation during the first 24 h. The overall incidence of admission to ICU fell from 1.9% in 1996 to 1.1% in 2003 (p<0.001). Overall hospital mortality was 3.2%. There was a significant decline in mortality from a peak of 4.7% in 1997 to 1.1% in 2003 (p = 0.014). This was despite increasing severity of illness (as evidenced by an increasing predicted risk of death derived from the APACHE II score) over the 8-year period (p = 0.002). CONCLUSIONS: There has been a significant decline in the incidence of asthma requiring ICU admission between 1996 and 2003 among units sampled by the Australian and New Zealand Intensive Care Society Adult Patient Database. The mortality of these patients has also decreased over time and is lower than reported in other studies.
Assuntos
Asma/terapia , Cuidados Críticos/estatística & dados numéricos , APACHE , Doença Aguda , Adulto , Asma/mortalidade , Austrália/epidemiologia , Mortalidade Hospitalar , Humanos , Tempo de Internação , Análise Multivariada , Respiração Artificial/estatística & dados numéricos , Resultado do TratamentoRESUMO
OBJECTIVE: To describe the development of a binational intensive care database. SETTING: One hundred thirty-eight intensive care units (ICUs) in Australia and New Zealand. METHODS: A structure was developed to enable ICUs to submit data for central and local analysis. Reports were developed to allow comparison with similar ICU types and against published mortality prediction models. The database was evaluated according to (a) the criteria of the Directory of Clinical Databases (DoCDat) and (b) a proposed framework for data quality assurance in medical registries. RESULTS: Between January 1987 and December 2003, 444,147 data sets were collected from 121 (72.5%) of 167 Australian and 10 (37.0%) of 27 New Zealand ICUs. Data sets from more than 60000 ICU admissions were submitted in 2003. Overall hospital mortality was 14.5%. The mean quality level achieved according to DoCDat criteria was high as was performance against a proposed framework for data quality. The provision of no-cost software has been vitally important to the success of the database. CONCLUSION: A high-quality ICU database has successfully been implemented in Australia and New Zealand and is now used as a routine quality assurance and peer review tool. Similar developments may be both possible and desirable in other countries.
Assuntos
Cuidados Críticos/normas , Bases de Dados Factuais , Unidades de Terapia Intensiva/normas , APACHE , Adulto , Austrália , Cuidados Críticos/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/economia , Unidades de Terapia Intensiva/estatística & dados numéricos , Prontuários Médicos , Nova Zelândia , Seleção de Pacientes , Revisão por Pares , Sistema de Registros , Reprodutibilidade dos TestesRESUMO
OBJECTIVE: To document current management of blood glucose in Australian and New Zealand intensive care units (ICUs) and to investigate the association between insulin administration, blood glucose concentration and hospital outcome. DESIGN AND SETTING: Practice survey and inception cohort study in closed multi-disciplinary ICUs in Australia and New Zealand. PATIENTS: Twenty-nine ICU directors and 939 consecutive admissions to 29 ICUs during a 2-week period. MEASUREMENT AND RESULTS: Data collected included unit approaches to blood glucose management, patient characteristics, blood glucose concentrations, insulin administration and patient outcomes. Ten percent of the ICU directors reported using an intensive insulin regimen in all their patients. In 861 patients (91.7%) blood glucose concentration was greater than 6.1[Symbol: see text]mmol/l, 287 (31.1%) received insulin, and the median blood glucose concentration triggering insulin administration was 11.5 (IQR 9.4-14) mmol/l. Univariate analysis demonstrated that non-survivors had a higher maximum daily blood glucose concentration (12 mmol/l, 9.4-14.8, vs. 9.5, 7.6-12.2) and were more likely to receive insulin (47% vs. 28%). Multiple logistic regression analysis showed age (OR per 5-year decrease 0.93, 95% CI 0.87-1.00) and APACHE II (OR per point decrease 0.87, 95% CI 0.84-0.90) to be independently associated with hospital mortality. After controlling for age and APACHE II both daily highest blood glucose (OR 0.95, 95% CI 0.90-1.00) and administration of insulin (OR 0.62, 95% CI 0.39-1.00) were independently associated when added to the model alone; neither was independently associated when they were simultaneously included in the model. CONCLUSION: Few Australian and New Zealand ICUs have adopted intensive insulin therapy. In this study, insulin administration and highest daily blood glucose concentration could not be separated in their association with hospital mortality.