Impact of clinical practice guidelines on priorisation for intensive care beds allocation in high-risk acute coronary syndrome patients: does age play a role?

Détails

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Etat: Public
Version: Final published version
ID Serval
serval:BIB_13315066C9AA
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Impact of clinical practice guidelines on priorisation for intensive care beds allocation in high-risk acute coronary syndrome patients: does age play a role?
Périodique
Swiss Medical Weekly
Auteur(s)
Wasserfallen J.B., Pinget C., Berger A., Eckert P., Stauffer J.C., Gillis D., Schaller M.D., Cornuz J., Kappenberger L., Yersin B.
ISSN
1424-7860
Statut éditorial
Publié
Date de publication
2006
Peer-reviewed
Oui
Volume
136
Numéro
41-42
Pages
655-658
Langue
anglais
Résumé
QUESTION UNDER STUDY: To assess which high-risk acute coronary syndrome (ACS) patient characteristics played a role in prioritising access to intensive care unit (ICU), and whether introducing clinical practice guidelines (CPG) explicitly stating ICU admission criteria altered this practice. PATIENTS AND METHODS: All consecutive patients with ACS admitted to our medical emergency centre over 3 months before and after CPG implementation were prospectively assessed. The impact of demographic and clinical characteristics (age, gender, cardiovascular risk factors, and clinical parameters upon admission) on ICU hospitalisation of high-risk patients (defined as retrosternal pain of prolonged duration with ECG changes and/or positive troponin blood level) was studied by logistic regression. RESULTS: Before and after CPG implementation, 328 and 364 patients, respectively, were assessed for suspicion of ACS. Before CPG implementation, 36 of the 81 high-risk patients (44.4%) were admitted to ICU. After CPG implementation, 35 of the 90 high-risk patients (38.9%) were admitted to ICU. Male patients were more frequently admitted to ICU before CPG implementation (OR=7.45, 95% CI 2.10-26.44), but not after (OR=0.73, 95% CI 0.20-2.66). Age played a significant role in both periods (OR=1.57, 95% CI 1.24-1.99), both young and advanced ages significantly reducing ICU admission, but to a lesser extent after CPG implementation. CONCLUSION: Prioritisation of access to ICU for high-risk ACS patients was age-dependent, but focused on the cardiovascular risk factor profile. CPG implementation explicitly stating ICU admission criteria decreased discrimination against women, but other factors are likely to play a role in bed allocation.
Mots-clé
Age Factors, Aged, Angina, Unstable, Female, Humans, Intensive Care Units, Male, Myocardial Infarction, Patient Admission, Practice Guidelines as Topic, Prospective Studies, Switzerland
Pubmed
Web of science
Création de la notice
14/03/2008 10:12
Dernière modification de la notice
20/08/2019 12:41
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