Intensive care units (ICUs) are specialist hospital wards providing intensive treatment to people with life-threatening critical illness. There may be long term consequences for survivors. A period of critical illness can be debilitating and the treatments themselves can be burdensome and costly. Doctors know what happens to most patients in the first weeks after they are discharged from an ICU. However, far less is known about what happens in the longer term to people who survive after their discharge from ICU, such as whether they develop long-term health complications or need more health services.
This study will join together national intensive care database (ICNARC) health data to GP and hospital health records in CPRD. We will examine whether the use of health services (GP visits, hospital admissions, use of medicines) differs between people who have had an ICU admission, and those who have not. We will also try to find out whether people who had been admitted to ICU are more likely to develop important health problems such as chronic kidney disease or dementia.
The results of this study will be very valuable for planning better health services and improving care for people after they are discharged from an ICU.
The long-term sequelae in survivors of intensive care are unknown, and it is important that we develop a better understanding of long-term health complications and health services utilisation. This will be achieved by comparing long-term outcomes of survivors of critical care with those individuals of similar previous health status who have not experienced a stay in critical care. This will be achieved by linking the UK national intensive care database (ICNARC) to GP and hospital episode statistics records in CPRD. Our key health service outcomes of interest are frequency/time-course of primary care consultations, prescribing burden, frequency of specialist referrals, frequency of hospital admissions, and number of hospital bed-days. Key index morbidities of interest are dementia/cognitive dysfunction, and chronic kidney disease (CKD). Rates of admission/consultation/referral/prescribing will be modelled using Poisson or negative binomial regression, as well as joint modelling with survival. Survival models will be constructed for the development of dementia/CKD. Multivariable mixed-effects regression will be employed to adjust for key covariates/confounders and clustering. The results of this study will be valuable for optimising health service delivery and improving care for people following discharge from an ICU.
David Menon - Chief Investigator - University of Cambridge
Rupert Payne - Corresponding Applicant - University of Bristol
Ari Ercole - Collaborator - Cambridge University Hospitals
David Harrison - Collaborator - ICNARC
Kirsty Rhodes - Collaborator - University of Cambridge
Rebecca Turner - Collaborator - University of Cambridge
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation;Other