Patients More Likely to Die While in ICU in U.S. Than in England
More study needed to discern if difference is due to intensive care overuse or underuse
FRIDAY, Oct. 30, 2009 (HealthDay News) -- Dying hospital patients in the United States are nearly five times more likely to spend their last days in the intensive care unit than patients in England, finds a new study, and U.S. patients over age 85 are eight times more likely to be in the ICU when they die.
That's the conclusion of Columbia University researchers who compared data from England and from seven states (Florida, Massachusetts, New Jersey, New York, Texas, Virginia and Washington).
Of all patients discharged from the hospital, 2.2 percent in England received intensive care, compared to 19.3 percent in the United States, according to the report published in the Nov. 1 issue of the American Journal of Respiratory and Critical Care Medicine.
The death rate among patients who received intensive care in England was nearly three times higher than in the United States (19.6 percent versus 7.4 percent). However, only 10.6 percent of hospital deaths in England involved the ICU, compared with 47.1 percent in the United States. Among patients over 85, 1.3 percent in England received ICU care, compared with 11 percent of those in the United States, the researchers found. Rates of ICU care for young adults and children were similar in both countries.
"These numbers need to be interpreted with caution as the differences in mortality for ICU patients likely reflect the higher severity of illness of patients admitted in the first place in England," lead author Dr. Hannah Wunsch, an assistant professor of anesthesiology and critical care medicine, said in a news release from the American Thoracic Society. "The data do bring up the interesting question of how much intensive care is beneficial. Doing more may not always be better," she added.
"In England, there is universal health care through the National Health Service, and there is also much lower per-capita expenditure on intensive care services when compared to the U.S.," Wunsch said. "The use of intensive care in England is limited by supply to a greater degree than it is in the U.S. and there are consequently implicit and explicit decisions regarding who gets those limited services. We wished to examine what different decisions are made," she explained.
"Whether less intensive care for very elderly patients who are dying is a form of rationing or is actually better recognition of what constitutes appropriate care at the end of life warrants further research," Wunsch said. "These findings highlight the urgent need to understand whether there is overuse of intensive care in the U.S., or under-use in England."
The American Thoracic Society has more about critical care.