Abstract 345: Hospital Variation in Admission to Intensive Care Units for Patients with Acute Myocardial Infarction
Bibliographic record
Abstract
Background: The intensive care unit (ICU) has been credited with reducing mortality for patients hospitalized with AMI in a past era when life-threatening post-infarction ventricular arrhythmias were more common. With the evolution in the clinical profile and treatment of AMI, the marginal benefit of ICU care for many patients is less clear. As a result, the use of ICU care for patients with AMI may vary substantially among institutions, creating implications for treatment strategies and patient outcomes. Methods: We identified 114,980 hospitalizations for AMI from 311 hospitals in the 2009-10 Premier database using ICD-9-CM codes. We excluded hospitals with <25 AMI admissions, patients <18 yrs, and transfers. Hospitals were stratified into quartiles by rates of ICU admission for AMI patients. For each quartile, we calculated (1) usage rates of critical care therapies and (2) in-hospital risk-standardized mortality rates (RSMRs) among all patients admitted with AMI. Kruskal-Wallis and Cochran-Armitage Trend tests assessed for statistical significance. Results: ICU admission rates for AMI patients varied markedly among hospitals (median 48%, IQR 35%-61%, range 0%-98%, Figure). Hospitals admitting more AMI patients to the ICU (higher quartiles) were (1) more likely to use critical care therapies in AMI patients overall (mechanical ventilation [Q1 to Q4: 13% to 16%], vasopressors/inotropes [17% to 21%], intra-aortic balloon pumps [4% to 7%], and pulmonary artery catheters [4% to 5%]; p for trend<0.05 in all comparisons). However, (2) there was no association between the hospital ICU admission rate and overall RSMR for all AMI patients (6% all quartiles; p=0.7271, Figure). Conclusion: ICU admission rates for AMI vary substantially across hospitals with evidence of greater use of ICU therapies in high admitting hospitals but without evidence of lower overall mortality. There is a need for further research to determine the optimal use of ICU care for contemporary populations of patients with AMI.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".