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Long‐term trends in critical care admissions in Wales

R. J. Pugh Orcid Logo, Rowena Bailey, T. Szakmany Orcid Logo, Mohammad Al Sallakh Orcid Logo, Joe Hollinghurst, Ashley Akbari Orcid Logo, Rowena Griffiths, C. Battle, C. Thorpe, C. P. Subbe, Ronan Lyons Orcid Logo

Anaesthesia, Volume: 76, Issue: 10, Pages: 1316 - 1325

Swansea University Authors: Rowena Bailey, Mohammad Al Sallakh Orcid Logo, Joe Hollinghurst, Ashley Akbari Orcid Logo, Rowena Griffiths, Ronan Lyons Orcid Logo

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DOI (Published version): 10.1111/anae.15466

Abstract

As national populations age, demands on critical care services are expected to increase. In many healthcare settings, longitudinal trends indicate rising numbers and proportions of patients admitted to ICU who are older; elsewhere, including some parts of the UK, a decrease has raised concerns with...

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Published in: Anaesthesia
ISSN: 0003-2409 1365-2044
Published: Wiley 2021
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URI: https://cronfa.swan.ac.uk/Record/cronfa56830
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spelling 2022-08-17T10:09:54.5840297 v2 56830 2021-05-08 Long‐term trends in critical care admissions in Wales 455e2c1e6193448f6269b9e72acaf865 Rowena Bailey Rowena Bailey true false 6efc53139ba1416418a6c6e584a25f2d 0000-0002-8333-7279 Mohammad Al Sallakh Mohammad Al Sallakh true false d7c51b69270b644a11b904629fe56ab0 Joe Hollinghurst Joe Hollinghurst true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 381464f639f98bd388c29326ca7f862c Rowena Griffiths Rowena Griffiths true false 83efcf2a9dfcf8b55586999d3d152ac6 0000-0001-5225-000X Ronan Lyons Ronan Lyons true false 2021-05-08 HDAT As national populations age, demands on critical care services are expected to increase. In many healthcare settings, longitudinal trends indicate rising numbers and proportions of patients admitted to ICU who are older; elsewhere, including some parts of the UK, a decrease has raised concerns with regard to rationing according to age. Our aim was to investigate admission trends in Wales, where critical care capacity has not risen in the last decade. We used the Secure Anonymised Information Linkage Databank to identify and characterise critical care admissions in patients aged ≥ 18 years from 1 January 2008 to 31 December 2017. We categorised 85,629 ICU admissions as youngest (18–64 years), older (65–79 years) and oldest (≥ 80 years). The oldest group accounted for 15% of admissions, the older age group 39% and the youngest group 46%. Relative to the national population, the incidence of admission rates per 10,000 population in the oldest group decreased significantly over the study period from 91.5/10,000 in 2008 to 77.5/10,000 (a relative decrease of 15%), and among the older group from 89.2/10,000 in 2008 to 75.3/10,000 in 2017 (a relative decrease of 16%). We observed significant decreases in admissions with high comorbidity (modified Charlson comorbidity index); increases in the proportion of older patients admitted who were considered ‘fit’ rather than frail (electronic frailty index); and decreases in admissions with a medical diagnosis. In contrast to other healthcare settings, capacity constraints and surgical imperatives appear to have contributed to a relative exclusion of older patients presenting with acute medical illness. Journal Article Anaesthesia 76 10 1316 1325 Wiley 0003-2409 1365-2044 ageing; comorbidity; critical care capacity; frailty; outcomes 1 10 2021 2021-10-01 10.1111/anae.15466 COLLEGE NANME Health Data Science COLLEGE CODE HDAT Swansea University Health and Care Research Wales; HDR UK Ltd. Grant Number: HDR-9006; UK Medical Research Council; Engineering and Physical Sciences Research Council; Economic and Social Research Council; Department of Health and Social Care (England); Chief Scientist Office of the Scottish Government Health and Social Care Directorates; Health and Social Care Research and Development Division (Welsh Government); Public Health Agency (Northern Ireland); British Heart Foundation; Wellcome Trust 2022-08-17T10:09:54.5840297 2021-05-08T16:11:48.3718273 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine R. J. Pugh 0000-0002-2848-4444 1 Rowena Bailey 2 T. Szakmany 0000-0003-3632-8844 3 Mohammad Al Sallakh 0000-0002-8333-7279 4 Joe Hollinghurst 5 Ashley Akbari 0000-0003-0814-0801 6 Rowena Griffiths 7 C. Battle 8 C. Thorpe 9 C. P. Subbe 10 Ronan Lyons 0000-0001-5225-000X 11 56830__24941__ed34d96421c74ecca52d5a3aaf9afc85.pdf 56830_VoR.pdf 2022-08-17T10:07:18.4285181 Output 509239 application/pdf Version of Record true © 2021 The Authors. This is an open access article under the terms of the Creative Commons Attribution License true eng http://creativecommons.org/licenses/by/4.0/
title Long‐term trends in critical care admissions in Wales
spellingShingle Long‐term trends in critical care admissions in Wales
Rowena Bailey
Mohammad Al Sallakh
Joe Hollinghurst
Ashley Akbari
Rowena Griffiths
Ronan Lyons
title_short Long‐term trends in critical care admissions in Wales
title_full Long‐term trends in critical care admissions in Wales
title_fullStr Long‐term trends in critical care admissions in Wales
title_full_unstemmed Long‐term trends in critical care admissions in Wales
title_sort Long‐term trends in critical care admissions in Wales
author_id_str_mv 455e2c1e6193448f6269b9e72acaf865
6efc53139ba1416418a6c6e584a25f2d
d7c51b69270b644a11b904629fe56ab0
aa1b025ec0243f708bb5eb0a93d6fb52
381464f639f98bd388c29326ca7f862c
83efcf2a9dfcf8b55586999d3d152ac6
author_id_fullname_str_mv 455e2c1e6193448f6269b9e72acaf865_***_Rowena Bailey
6efc53139ba1416418a6c6e584a25f2d_***_Mohammad Al Sallakh
d7c51b69270b644a11b904629fe56ab0_***_Joe Hollinghurst
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
381464f639f98bd388c29326ca7f862c_***_Rowena Griffiths
83efcf2a9dfcf8b55586999d3d152ac6_***_Ronan Lyons
author Rowena Bailey
Mohammad Al Sallakh
Joe Hollinghurst
Ashley Akbari
Rowena Griffiths
Ronan Lyons
author2 R. J. Pugh
Rowena Bailey
T. Szakmany
Mohammad Al Sallakh
Joe Hollinghurst
Ashley Akbari
Rowena Griffiths
C. Battle
C. Thorpe
C. P. Subbe
Ronan Lyons
format Journal article
container_title Anaesthesia
container_volume 76
container_issue 10
container_start_page 1316
publishDate 2021
institution Swansea University
issn 0003-2409
1365-2044
doi_str_mv 10.1111/anae.15466
publisher Wiley
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
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description As national populations age, demands on critical care services are expected to increase. In many healthcare settings, longitudinal trends indicate rising numbers and proportions of patients admitted to ICU who are older; elsewhere, including some parts of the UK, a decrease has raised concerns with regard to rationing according to age. Our aim was to investigate admission trends in Wales, where critical care capacity has not risen in the last decade. We used the Secure Anonymised Information Linkage Databank to identify and characterise critical care admissions in patients aged ≥ 18 years from 1 January 2008 to 31 December 2017. We categorised 85,629 ICU admissions as youngest (18–64 years), older (65–79 years) and oldest (≥ 80 years). The oldest group accounted for 15% of admissions, the older age group 39% and the youngest group 46%. Relative to the national population, the incidence of admission rates per 10,000 population in the oldest group decreased significantly over the study period from 91.5/10,000 in 2008 to 77.5/10,000 (a relative decrease of 15%), and among the older group from 89.2/10,000 in 2008 to 75.3/10,000 in 2017 (a relative decrease of 16%). We observed significant decreases in admissions with high comorbidity (modified Charlson comorbidity index); increases in the proportion of older patients admitted who were considered ‘fit’ rather than frail (electronic frailty index); and decreases in admissions with a medical diagnosis. In contrast to other healthcare settings, capacity constraints and surgical imperatives appear to have contributed to a relative exclusion of older patients presenting with acute medical illness.
published_date 2021-10-01T04:07:30Z
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