This seems like a no-brainer. Some elderly patients may benefit from early transfer to the ICU.
From Medscape (need subscription): Transfer to an intensive care unit (ICU) may yield greater benefits with increasing age and increasing severity of illness, according to researchers who used an updated mathematical technique in their modeling.
ICU transfer has been associated with increased mortality in observational studies. Those studies, however, relied on risk-adjustment methods that did not address confounding by indication or potential heterogeneity in the effectiveness of ICU care, depending on a patient’s prognosis.
The new method, which uses an updated instrumental variable analytical technique, addresses both issues, and reports person-centered treatment effects, Dr. Steve Harris of University College London told Reuters Health by email. Specifically, it uses “pseudo-randomizers” that predict the type of treatment a patient will receive but don’t directly affect outcomes.
For the current study, the pseudo-randomizer was the fluctuating occupancy rates of ICUs, which may block or delay admission. The smallest changes in the rate can identify pairs of patients with different degrees of illness severity, but whose admission to the ICU depends mainly on space availability, Dr. Harris explained. (more….)