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Resuscitation. 2016 Aug;105:123-9. doi: 10.1016/j.resuscitation.2016.05.014. Epub 2016 May 30.

Acute respiratory compromise on inpatient wards in the United States: Incidence, outcomes, and factors associated with in-hospital mortality.

Author information

1
Department of Medicine, Regional Hospital Holstebro, Aarhus University, Holstebro, Denmark; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.
2
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
3
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
4
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Anesthesia Critical Care, Division of Critical Care, Beth Israel Deaconess Medical Center, MA, USA.
5
Harvard Clinical Research Institute, Boston, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
6
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Medicine, Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: mdonnino@bidmc.harvard.edu.

Abstract

AIM:

To estimate the United States' incidence and in-hospital mortality of acute respiratory events on inpatient wards and to identify factors associated with mortality.

METHODS:

This is an analysis of prospectively collected data from the Get With the Guidelines(®) - Resuscitation registry. We included adult patients with index acute respiratory events on inpatient wards from January 2005 to December 2013. A negative binomial regression model was used to estimate the 2012 United States incidence and a multivariable logistic regression model was used to examine time trends and characteristics associated with in-hospital mortality.

RESULTS:

There were 13,086 index events from 320 hospitals included in the analysis. Using 2012 data, the estimated number of events in the United States was 44,551 (95%CI: 25,170-95,371). The in-hospital mortality for the entire cohort was 39.4% (95%CI: 38.5, 40.2) and rose to 82.6% (95%CI: 79.9, 85.2) for events leading to cardiac arrest. There was a decrease in in-hospital mortality over time (48.3% in 2005 to 34.5% in 2013, p<0.001). Characteristics associated with mortality included agonal breathing, hypotension and septicemia.

CONCLUSIONS:

Acute respiratory events on inpatient wards in the US is common with an associated in-hospital mortality of approximately 40% that has been decreasing over the past decade. Multiple factors were associated with in-hospital mortality.

KEYWORDS:

Epidemiology; Intubation; Pulmonary ventilation; Respiratory insufficiency; Survival

[Indexed for MEDLINE]

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