16-ICU Telemedicine and Clinical Factors Related to 30-Day Mortality: A Retrospective Cohort Study
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Administration, Research, 2021
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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Chiedozie I. Udeh


Introduction/Hypothesis: ICU telemedicine (ICU-TM) has expanded in the U.S addressing critical care coverage demands. Evidence of its impact on clinical outcomes is growing. This study evaluated the association of ICU telemedicine exposure or non-exposure and relevant clinical factors with 30-day mortality.

Methods: This was a retrospective, cohort study of 153,987 consecutive ICU patients drawn from an institutional, ICU dataset for 9 hospitals with APACHE IV scoring, from 2014 to 2020. Analyses included summary statistics for demographics, 30-day mortality, multivariate logistic regression modeling, and survival analysis.

Results: For the entire cohort the unadjusted 30-day mortality proportion was significantly different between patients with ICU telemedicine (5.5%) or without ICU-TM (6.9%) with a risk ratio of 0.80 (95% CI 0.77, 0.84) (p <0.0001). Mortality rate for ICU-TM and no ICU-TM was 2.45/1000 versus 3.18/1000 patient-days respectively (p < 0.0001). Multivariate logistic regression modeling showed that ICU-TM exposure was associated with reduced 30-day mortality (OR 0.82, 95% CI 0.77, 0.87). In the final model, increased risk was seen with admission after cardiac arrest (1.42, 95% CI 1.26, 1.59), weekend admission (OR 1.29, 95% 1.18, 1.41), emergency admission (1.18, 95% CI 1.12, 1.24), race (non-white) (OR 1.11, 95% CI 1.05, 1.17), sepsis (OR 1.06, 95% CI 1.00, 1.12), day 1 APACHE score (OR 1.03, 95% CI 1.03, 1.03), and ICU LOS, (OR 1.01, 95% CI 1.01, 1.02). Risk reduction occurred with hospital LOS (OR 0.95, 95% CI 0.95, 0.96), surgical admission (OR 0.67, 95% CI 0.63, 0.72), coma (OR 0.48, 95% CI 0.36, 0.64) and 2 interaction terms (weekend admission with ICU telemedicine (OR 0.80, 95% CI 0.72, 0.90) and afterhours admission with ICU telemedicine (OR 0.78, 95% CI 0.73, 0.82)). The model has a c-statistic of 0.77. Secondary analyses showed that ICU and hospital length of stays were significantly reduced in the ICU telemedicine group (-1.6 days, 95% CI -1.5, -1.7) and -2.1 days (95% CI -1.9, -2.4), respectively.

Conclusions: In this large cohort, ICU telemedicine appears to be one of several factors associated with reduced 30-day mortality of ICU patients.



Meta Tag
Content Type Presentation
Knowledge Area Administration
Knowledge Area Research
Knowledge Level Intermediate
Knowledge Level Advanced
Membership Level Select
Tag Telemedicine eICU
Tag Outcomes Research
Year 2021
ICU telemedicine
30-day mortality
patient outcomes
ICU length of stay
hospital length of stay


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