Severity of illness and the relationship between intensive care and survival.

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Abstract
Currently .apprx. 15% of hospital costs are attributed to intensive care. Research using statistical models has not adequately demonstrated that therapy in intensive care units (ICU) is associated with reductions in the probability of death. In 613 consecutive admissions to a multidisciplinary ICU, the relationship between ICU care and survival was studied using a new acute physiology scoring system to control for the severity of illness of the patient population. When this severity of illness index was employed, a statistically significant and nonlinear relationship was found between the use of intensive medical care and the probability of survival. This statistical relationship produced a U-shaped curve with 3 distinct segments. The 1st segment exhibited an overall decrease in the probability of death with increasing therapy (275 admission); the 2nd segment demonstrated a fairly stable survival rate (281 admissions). Only in the 3rd segment, where there were 57 admissions, was an overall increase in the probability of death found as utilization of therapy increased. Quantitative measurement of severity of illness, when used in clinical studies, could produce improved insights into the relationship between therapy and health outcomes.