Resource Allocation in Neonatal and Medical ICUs: Epidemiology and Rationing at the Extremes of Life
Lantos, John D.
American Journal of Respiratory and Critical Care Medicine. 1997 Jul; 156(1): 185-189.
This study compared resource allocation to patients who eventually die in neonatal ICUs (NICUs) and adult medical ICUs (MICUs). It was performed via retrospective, chart review study at ICUs at the University of Chicago-an inner city, tertiary care, academic medical center. All patients were admitted to the neonatal, general medical, or coronary ICU during 1 calendar yr. Overall mortality in the NICU (66/827; 7.9%) was significantly lower than in the adult ICUs (219/1320; 16.5%) (p less than 0.001). However, mortality for the smallest newborns (less than 751 g; 51% mortality) was higher than for the oldest adults (greater than 54 yr; 30% mortality) (p = 0.05). Fifty-six percent (37/66) of all neonates who died in the NICU did so within the first 48 hr of life. In contrast, nearly two-thirds (134/219) of adult ICU deaths occurred after 48 hours in the ICU (p less than 0.02). The percentage of ICU bed-days devoted to nonsurviving adults (28.8%) was significantly larger than the percentage of NICU bed-days devoted to nonsurviving babies (7.8%). Even among babies at greatest risk to die (birth weight less than 751 g), the percentage of NICU bed-days allocated to nonsurviving infants was less than 20%. In contrast, for the oldest ICU patients (greater than 84 yr) this value exceeded 50%, for ICU patients greater than 84 yr old who required mechanical ventilation, the percentage of ICU bed-days allocated to nonsurvivors approached 90%. Care for the elderly in MICUs involves a far greater proportional expenditure of money toward those who will not survive than does care for newborns in NICUs. To the extent that allocation decisions are driven by concerns about distributive justice and the efficient use of scarce resources, it would be more justifiable to ration intensive care for the very old than the very young.
Adults; Age Factors; Aged; Biomedical Technologies; Birth Weight; Comparative Studies; Costs and Benefits; Epidemiology; Hospitals; Infants; Intensive Care Units; Justice; Life; Low Birth Weight; Minors; Mortality; Newborns; Neonates; Patient Care; Patient Discharge; Patients; Prematurity; Resource Allocation; Review; Risk; Time Factors; Ventilators;
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Birth Weight-Specific Mortality for Extremely Low Birth Weight Infants Vanishes by Four Days of Life: Epidemiology and Ethics in the Neonatal Intensive Care Unit Meadow, William; Reimshisel, Tyler; Lantos, John (1996-05)BACKGROUND. The persistent differences between those who question the appropriateness of aggressive resuscitative measures for many extremely low birth weight (ELBW) infants (birth weight less than 1001 g) and those ...
Birth Weight-Specific Mortality for Extremely Low Birth Weight Infants Vanishes by Four Days of Life: Epidemiology and Ethics in the Neonatal Intensive Care Unit Meadow, William; Reimshisel, Tyler; Lantos, John (1996-05)