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GiViTIGruppo Italiano per la Valutazione degli Interventi In Terapia Intensiva

ReportPROSAFE project

Year 2011

National report for general ICUs (163 ICUs)

ITALY

SESTANTE EDIZIONI - BERGAMO

PROSAFE project

PROSAFE project - National report for general ICUs (163 ICUs) - ITALYMay 2012

Authors of the report:Carlotta Rossi, Bergamo - ITGiovanni Nattino, Bergamo - ITFrank Bloos, Jena - DAkos Csomos, Budapest - HUJoanne Fleming, Padova - ITRafael Kapš, Novo Mesto - SITheodoros Kyprianou, Nicosia - CYMikaszewska-Sokolewicz Malgorzata, Warsaw - PLGiuseppe Nattino, Lecco - ITLuana Nava, Bergamo - ITDaniele Poole, Belluno - ITMervyn Singer, London - UKMario Tavola, Lecco - ITGuido Bertolini, Bergamo - IT

Software developers:Luca Antiga, Bergamo - ITMauro Bianchi, Bergamo - ITDaniele Crespi, Bergamo - ITObou Brissy, Bergamo - IT

GiViTI Coordinating CenterDaccò Center for Clinical Research on Rare DiseasesMario Negri Institute for Pharmacological ResearchVilla Camozzi - 24020 Ranica (BG), ITtel: +390354535313email: [email protected]

The PROSAFE project was realized thanks to a grant from European Union (DGSANCO Contract No. 2007331).GiViTI thanks Astellas, Bellco, Brahms, Hill-Rom for the unconditional grants for the year 2011.

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PROSAFE project

Contents

Preface 5

The project 7

Data collection 7

The reports 7

Description of the statistics 8Project participation and location of Italian partecipating ICUs . . . . . . . . . . . . . . . . . . . . . . . . . . 8Description of the hospitals and ICUs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Study flow-chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Description of patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Statistics 15Project participation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Location of Italian participating ICUs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Description of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Description of ICUs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Study flow-chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Description of adult patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Analysis of hospital mortality (GiViTI 2011): forest plot . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Description of adult patients with LOS>=24 hours evaluated in the GiViTI model . . . . . . . . . . . . . . . 37Description of adult non surgical patients with LOS>=24 hours evaluated in the GiViTI model . . . . . . . . 49Description of adult elective surgical patients with LOS>=24 hours evaluated in the GiViTI model . . . . . . 61Description of adult emergency surgical patients with LOS>=24 hours evaluated in the GiViTI model . . . . 73Description of adult patients with LOS<24 hours evaluated in the GiViTI model . . . . . . . . . . . . . . . . 85Description of adult elective surgical patients with LOS<24 hours evaluated in the GiViTI model . . . . . . . 97Description of pediatric patients evaluated with PELOD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109

Appendix 121Prognostic models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123Validity of the models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127Coauthors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129

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PROSAFE project

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PROSAFE project

Preface

The tenth year of the Margherita project coincided with a radical change. Thanks to funding from the European Union

(DG SANCO contract No. 2007331), the project crossed the Italian borders to become PROSAFE and is now shared

by intensive care units in Cyprus, Hungary, Italy, Poland, Slovenia, and Switzerland, not to mention the involvement of

the units of the non-government organization EMERGENCY, in Afghanistan and Sudan.

However, PROSAFE cannot be considered the mere extension of the existing project. The Margherita project has

instead been entirely overhauled: from the case report form to the data collection software, from the statistical

analyses to the yearly reports. Such important changes have also caused some problems and discontent, resulting in

the decline, for the first time in ten years, in the number of Italian ICUs, from 238 to 210 participants, partly offset by

15 new non-Italian centers. Despite these numbers, however, we must consider PROSAFE to be a complete success,

far beyond all expectations.

The work behind these pages has continued for over three years and involved all the European centres in a

partnership that has proven extremely fruitful and enjoyable, and has produced solid friendships. This very element

has contributed important added value to the project. Indeed, only when you build relationships based on genuine

collaboration can you achieve results that exceed the sum of individual expertise.

Many tools have been developed to handle the PROSAFE project: the main software, the translation manager, the

registration tool, the technical assistance program, the website, the data analyzer, the report generator, etc. All are

extremely complex and advanced and have clearly required extraordinary commitment. They still have to be updated

and improved, but they mark the achievement of an important milestone and the best investment for the future of the

project.

This report opens a new course for the evaluation and improvement of quality of care in intensive care medicine.

It may be more challenging than before, but judging from the international arena being created and the ideas and

prospects being generated, it will undoubtedly be even more exciting and beneficial.

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PROSAFE project

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PROSAFE project

The project

The PROSAFE project was conceived as an observational project for the continuous electronic collection of data on

patients admitted to intensive care units (ICUs). The objectives of the project are to:

• standardize the procedures for collecting data on admitted patients;

• analyse the activity carried out in terms of both clinical results achieved and resources used;

• gather information on the collected case series for research and/or routine clinical management purposes;

• promote comparison among ICUs, on the basis of detailed epidemiological research work, with a view to improving

the quality of the care provided.

In addition to these general objectives, the PROSAFE project provides a tool that serves as the operating base for

all research projects undertaken by the individual ICUs, both under the umbrella of the GiViTI group and at local

level. The PROSAFE program, by virtue of its modular structure, is designed to smoothly integrate the collection of

basic data (the PROSAFE ’core’) with the collection of specific data for research projects focused on various different

topics (the PROSAFE ’petals’).

The Petals functioning in 2011 in Italy were:

• the Infections Surveillance Petal, designed to describe the epidemiology of infections in ICUs in Italy, focusing

specifically on the identification and study of the main risk and prognostic factors for infections, with a view to

comparing the various ICUs in terms of incidence of infections and their severity, prevalent bacterial flora and

multiresistant germs;

• the Cardiosurgical Petal, whose aim is to describe in detail the characteristics of patients admitted to the ICU and

subject to one or more cardiosurgical procedures;

• the Crimyne 2 Petal, designed to assess the accuracy (in terms of sensitivity and specificity), in the diagnosis of

CRIMYNE (CRitical Ilness MYopathy and NEuropathy), of the simplified peroneal CMAP test, using the complete

ENG-EMG test as the diagnostic gold standard;

• the StART Petal, whose objective is to assess the appropriateness of ICU bed utilization by comparing the level of

care required by admitted patients with the level of care that can be provided using available resources.

The information currently collected in the program ’core’ refers to personal patient data, information on origin, reason

for admission and whatever else GiViTI has, over the years, determined to be needed to best describe patients

admitted to intensive care.

Data collection

The PROSAFE software is distributed free of charge to all ICUs taking part in the project. To date, 355 ICUs have

joined the project: 313 Italian and 42 foreign ICUs. 290 ICUs collected data during 2011 for a total of 88578 patients

registered in PROSAFE. Only the ICUs that collected valid data (225) for a period of over 4 months were included in

the aggregate analyses. On the whole, therefore, the assessment was based on a total of 73163 patients admitted to

intensive care during 2011.

The reports

The Coordinating Centre (GiViTI) produces the following reports (only for subgroups composed of at least 5 ICUs):

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PROSAFE project

1. The (Italian and Hungarian) national report on the general (medical/surgical) ICUs. This first report includes the

logistic regression model to assess performance in the various ICUs taking part in the project. The statistics for

the most representative regions can be downloaded from the GiViTI website (www.giviti.marionegri.it).

2. The (Italian) national report on the surgical ICUs.

3. The (Italian) national report on the neurosurgical ICUs.

4. The personalized report for each individual centre, in Italian or English, which has different sections according to

type of ICU and a similar structure to the national report, is designed to foster precise but user-friendly interpretation

of the various values for predicting hospital mortality.

All reports (except for the personalized reports, sent to the project Contact person and the Director of the ICU) can

be downloaded from the PROSAFE Project section of the GiViTI website (www.giviti.marionegri.it). An analysis

application form is available on the GiViTI website to obtain a report on particular subgroups of patients in which

each unit may be interested.

Description of the statistics

Project participation and location of Italian partecipating ICUs

The table on page 17 summarizes the participation in the project of the 225 ICUs which collected valid data in 2011

for a period of at least 4 months.

The map on page 19 shows the geographical location of the ICUs assessed in the report.

Description of the hospitals and ICUs

This section presents the organizational-structural features of the ICUs included in the report. The information (except

for the information shown in the grey box, which is the result of joint analysis of data reported at the time of registration

and those collected during the year via the software) is taken from the PROSAFE project registration forms. Absolute

numbers, percentages and the number of missing data are reported for the categorical variables; the mean, standard

deviation, median and Q1 (first quartile: the value below which lie 25% of the population) and Q3 (third quartile: the

value below which lie 75% of the population) serve as indicators for the continuous variables. Data on the number of

staffed beds, total admissions in 2011 and ICU stay days were used to calculate indicators of utilization, i.e. indicators

able to measure utilization levels and healthcare facility activity levels.

The bed occupation rate expresses bed occupancy as a percentage value, by dividing total ICU stay days recorded

at a given time by the total number of days in the period in question multiplied by the number of staffed beds. The

product corresponds to the ICU’s total availability for admissions (daily number of available beds); the closer total

ICU stay days are to total availability, the more the occupation rate tends towards 100%. Occupation rate can even

exceed 100% when a new patient is admitted to a bed that became vacant on the same day.

Occupation rate =ICU stay days

Days×Number of beds(1)

The rotation index expresses the mean number of patients ’staying’ in a bed in one year. It is calculated by dividing

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PROSAFE project

the number of admissions by the number of beds. Data collected for less than one year have to be extrapolated.

Rotation index =Number of patients

Number of beds(2)

The turnover interval expresses the period of time in which a bed remains vacant between two consecutive patients.

It is calculated by dividing the number of days with vacant beds by the number of patients admitted during the period

in question, giving mean unoccupied time per bed. It is calculated by dividing the number of days with unoccupied

beds by the number of patients admitted in the period in question. This gives the mean unoccupied time per bed.

This indicator is expressed in hours.

Turnover = 24× (Number of beds×Days)− ICU stay days

Number of patients(3)

Study flow-chart

The flow chart, or tree diagram, on page 23 presents the various subgroups of analysed patients. PROSAFE has a

very accurate indicator of the completeness and validity of the data entered on each patient, i.e. status.

The program envisages 5 status levels:

• status 1 - the patient record presents errors or unsolved warnings;

• status 2 - the record is incomplete, there are still missing data;

• status 3 - the patient has been discharged from the ICU, the clinical data are all entered and have undergone

congruency checks; only hospital outcome is missing;

• status 4 - record complete and free of errors;

• status 5 - record free of errors but incomplete; the missing data are irretrievable.

Patients with status 1, 2 and 5 data are clearly incomplete.

It would be wrong to omit only patients with incomplete data (in status 1, 2 and 5) from the analyses since this could

skew the estimates because of a so-called ’selection bias’. Patients with incomplete data may instead represent

a special population subgroup. If only these patients were omitted from the analysed group, the statistics would

no longer represent the whole group. It is plausible to assume, for example, that the majority of the patients for

whom hospital outcome is missing were discharged alive from hospital, since it is much easier and quicker to retrieve

information on hospital outcome when a patient has died. Calculating statistics on hospital mortality in the whole

group of patients would result in mortality being incorrectly overestimated.

To address this problem it was decided to omit from each individual ICU’s data any patients recruited during months

when the validity percentages were below a high threshold (90%). Another check performed to reduce the risk of

selection bias is to analyse the number of patients admitted per month. If the number of patients admitted in one

or more months differs significantly from the mean number of monthly admissions (with a threshold arbitrarily set

at a mean of +/- 2 trimmed SD), or if the variability in the number of admissions is too high (variation coefficient

above 40%), a warning message will appear asking for the entered data to be checked. To correctly participate in the

PROSAFE project, all patients consecutively admitted to the ICU must be registered in the software on a continuous

basis throughout the year; any marked swings in the number of admissions should suggest that there may be patient

registration ’gaps’. It is, however, impossible to distinguish between registration ’gaps’ and periods in which there is a

real reduction/increase in admissions. Hence our objective is to draw attention to potential problems by asking each

individual centre for feedback.

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PROSAFE project

To more clearly illustrate the selection methods used in the choice of valid data, we present an extract from the data

validity report of a randomly selected, anonymized ICU.

From January to December, Centre XX000 recruits a total of 269 patients. The first table and the bar graph show the

number of monthly admissions to intensive care. In this case, a warning will appear at the bottom of the bar graph

asking for confirmation of the entered data.

The second table divides the recruited patients by admission month and form completion status. Overall, the ICU in

question presents complete data for the majority of recruited patients. Only 7 patients still present incomplete data.

The final graph shows level of data completeness in the various months.

According to our elimination criterion, the overall analysis of hospital mortality will exclude those patients admitted in

the month of May since they present a validity percentage below 90% (in that month, information on hospital outcome

was still missing for 3 out of 24 patients). Accordingly, 245 patients have valid data for this type of analysis (after

subtracting the 24 patients admitted in the month of May from the total of 269 patients).

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PROSAFE project

Description of patients

These sections of the report present the results of the analyses conducted on the group of patients with valid data.

Patients admitted in the months with less than 90% admissions in statuses 3 and 4 are omitted from the analysis

group. This part presents patient characteristics at ICU admission and during ICU stay, severity scores, process

indicators, and outcomes for the various patient subgroups.

Absolute number, percentage and number of missing data are reported for the categorical data, while mean, standard

deviation, median, interquartile range (Q1-Q3) and minimum and maximum range are reported for continuous

variables. The acronym 95% CI indicates the 95% confidence interval of the estimate.

Below are a few tips on how to correctly interpret the analyses.

BMI The calculation of Body Mass Index is based on weight and height values, with the following formula:

BMI =weight (kg)

height (m)2(4)

The categories of underweight, overweight and obese are determined according to the following criteria: underweight if

BMI<20 (males) or BMI<19 (females); normal weight if 20<=BMI<=25 (males) or 19<=BMI<=24 (females); overweight

if 25<BMI<=30 (males) or 24<BMI<=29 (females); obese if BMI>30 (males) or BMI>29 (females).

Stay before ICU Days spent between admission to hospital and admission to ICU.

Reason for transfer from other ICU The reported items refer to the following reasons:

• Specialist expertise -> specialist expertise within the hospital;

• Step-up care -> management of high complexity critical patient;

• Logistical/organizational reasons -> continuation of treatment in stabilized patient (transfer for logistic/ organizational

reasons);

• Step-down care-> continuation of treatment in a non-specialist environment.

Surgical interventions on admission (top 10) This lists the top 10 surgical interventions, divided by elective surgery

and emergency surgery patients, operated between 7 days prior to and one day after admission to the ICU.

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PROSAFE project

Multiple trauma The category multiple trauma is defined by the presence of trauma in two or more regions.

SAPSII The score cannot be calculated if GCS (first 24 hours) is unassessable.

The SAPSII score for individual patients can become the probability of dying in hospital. This is performed by the

following formula:

Predicted hospital mortality =eLogit

1 + eLogit(5)

where

Logit = −7.763 + 0.074× SAPSII + 0.997× ln (SAPSII + 1) (6)

PELOD The PELOD score for individual pediatric patients can become the probability of dying in ICU. This is

performed by the following formula:

Predicted ICU mortality =1

1 + e7.64−0.30×PELOD(7)

Severity evolution (of infections) The severity of infection on admission is shown in the rows. Maximum severity

reached during ICU stay is indicated in the columns. The table reports the absolute numbers and row percentages by

which to assess the evolution of infection severity. For example, in the case below, the severity of the infection did not

worsen during ICU stay in 15 out of the 17 patients admitted with SEVERE SEPSIS (15/17=88.2%). Conversely, the

condition of SEVERE SEPSIS developed into SEPTIC SHOCK in 2 patients (2/17=11.8%).

VAP Forms of pneumonia associated with invasive ventilation are defined as VAP (pneumonia onsetting after the 2nd

day of ventilation or developing within 2 days of the end of ventilation).

Incidence of VAP Two different incidence rates are presented:

Incidence of VAP =Number of patients with VAP during stay

Mechanical ventilation days pre VAP× 1000 (8)

where the variable mechanical ventilation days pre-VAP corresponds to the total number of mechanical ventilation

days pre-VAP of all patients admitted to the ICU. It is equal to the total duration of mechanical ventilation for patients

who do not develop VAP and to the difference between the date of onset of VAP and the start date of mechanical

ventilation for infected patients. The mechanical ventilation days in patients who were discharged or died within 2

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PROSAFE project

days of the start of ventilation are excluded from the denominator.

Incidence of VAP =Number of patients with VAP during stay

(Mechanical ventilation days pre VAP)/8× 100 (9)

The second rate is only a reworking of the previous one, to simplify interpretation of the data. It answers the question:

’Out of 100 patients ventilated for 8 days in the ICU, how many develop VAP?’. The 8-day cut off has been set by

convention. The rates are accompanied by 95% confidence intervals.

Incidence of CR-BSI Just like VAP, two incidence rates are presented for catheter-related blood stream infections:

Incidence of CRBSI =Number of patients with CRBSI during stay

CVC days pre CRBSI× 1000 (10)

Incidence of CRBSI =Number of patients with CRBSI during stay

(CVC days pre CRBSI)/12× 100 (11)

The second one responds to the question ’Out of 100 theoretical patients catheterized for 12 days in the ICU, how

many will develop catheter-related blood stream infections?’.

Invasive ventilation (approach) The reported items refer to the following scenarios:

• Due to pulmonary failure -> invasive ventilation in a patient with hypoxic and/or hypercapnic respiratory failure;

• For airway mainteinance -> invasive ventilation in a patient without respiratory failure, to support airways (e.g. coma

patient);

• In weaning -> final part of invasive ventilation in a patient admitted for weaning from ventilation.

Non invasive ventilation (approach) The reported items refer to the following scenarios:

• Non invasive ventilation only -> non-invasive ventilation as the only ventilatory approach to the patient;

• Non invasive ventilation failed -> non-invasive ventilation immediately followed by patient intubation;

• For weaning -> non-invasive ventilation started within one day of the end of invasive ventilation.

Surgical interventions during stay (top 10) The surgical interventions performed from the second day of stay.

Reason of transfer to other ICU See the item ’Reason of transfer from other ICU’.

Hospital mortality Statistics on hospital outcome (indicated with an asterisk, where necessary) involve the subgroup

of patients with valid data for this variable or patients admitted during the months when over 90% of patients were in

status 4, after excluding readmissions from another hospital ward.

Readmissions Only readmissions from other hospital wards are considered.

ICU stay (days) Length of pre-ICU, post-ICU and hospital stay are simply calculated as the difference between

dates. Calculation of ICU stay can be optimized by using time of patient admission and discharge. The difference

between the discharge date and the admission date is calculated. 1 is added if the patient is admitted before 12:00

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PROSAFE project

and discharged after this time. Conversely, 1 is subtracted if the patient is admitted after midday and discharged

before midday. If the length of stay in the ICU is equal to 0, length of stay is entered as 1.

Analysis of mortality: forest plot The graph shows the various O/E scores of the ICUs involved in the project. The

O/E score is given by the ratio between the total number of expected deaths (according to the indicated reference

model) and the total number of observed deaths. The dotted line, in correspondence to the value of 1, separates the

ICUs with lower or higher mortality than predicted by the model. Each estimate is accompanied by a 95% confidence

interval.

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PROSAFE project

Statistics

15

PROSAFE project

16

PROSAFE project

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17 Project participation

PROSAFE project

18

Location of Italian participating ICUs (N=163)ICUs per region

0

1 − 2

3 − 5

6 − 10

11 − 20

oltre 20

Region N %

Abruzzo 3 1.8Basilicata 1 0.6Calabria 2 1.2

Campania 9 5.5Emilia Romagna 18 11

Friuli-Venezia Giulia 0 0Lazio 3 1.8

Liguria 4 2.5Lombardia 38 23.3

Marche 5 3.1Molise 0 0

Piemonte 22 13.5Puglia 2 1.2

Sardegna 1 0.6Sicilia 5 3.1

Region N %

Toscana 23 14.1Trentino Alto Adige 1 0.6

Umbria 3 1.8Valle d’Aosta 1 0.6

Veneto 22 13.5

Geographical area N %

Northern Italy 106 65Central Italy 37 22.7

Southern Italy 20 12.3

PROSAFE project

19 Participating ICUs

PROSAFE project

20

Description of hospitals (N=163) - Year 2011

Number of beds in hospital N %

< 300 beds 85 52.1300 - 800 beds 59 36.2

> 800 beds 19 11.7Missing 0

Non surgical specialties N %

Cardiology 157 96.3Pneumology 85 52.1Nephrology 125 76.7

Infectious diseases 66 40.5Pediatrics 132 81.0

Neonatology 93 57.1Neurology 118 72.4

Haematology 73 44.8

Surgical specialties(independent ward) N %

Neurosurgery 53 32.5Cardiosurgery 36 22.1

Major vascular surgery 74 45.4Thoracic surgery 61 37.4Pediatric surgery 33 20.2

Transplantation activities (excludingcorneal transplants)

30 18.4

Surgical specialties(procedures only) N %

Neurosurgery 9 5.5Cardiosurgery 4 2.5

Major vascular surgery 19 11.7Thoracic surgery 35 21.5Pediatric surgery 28 17.2

Transplantation activities (excludingcorneal transplants)

14 8.6

Type of ICUs present in hospital N %

General 163 100.0Medical 1 0.6Surgical 9 5.5

Neurosurgical 21 12.9Cardiosurgical 34 20.9Coronary unit 120 73.6

Burns 5 3.1Transplants 14 8.6

Pediatrics 18 11.0High dependency unit 28 17.2

Respiratory Intensive Care Unit 17 10.4Other 29 17.8

Services/activities available in H N %

Invasive radiology 84 51.5Invasive cardiology 109 66.9

Endoscopy 148 90.8Microbiology 132 81.0

Emergency department 143 87.7

1 ICU 2 ICUs 3 ICUs 4 ICUs 5 ICUs 6 ICUs 7 ICUs > 7 ICUs

Number of ICUs in hospital

0

20

40

60

80

31

73

20

10 12

5 5 7

PROSAFE project

21 Description of hospitals

Description of ICUs (N=163) - Year 2011

Number of functioning bedsMean 7.1

SD 2.8Median 6Q1-Q3 5-8

Missing 0

University affiliation N %

Yes 40 24.5No 123 75.5

Missing 0

Number of physicianMean 11.2


Missing 0

Physicians N %

Dedicated to ICU only 44 27.2Dedicated to ICU on a rotation basis 13 8.0

Dedicated to ICU only and on arotation basis

105 64.8

Missing 1

Beds per physician (average)Mean 4.3

SD 1.7Median 4Q1-Q3 3.2-5

Missing 0

Beds per physician (night-time)Mean 6.0


Missing 0

Number of nursesMean 23.8

SD 12.5Median 20Q1-Q3 16-28.5

Missing 0

Nurses N %

Dedicated to ICU only 105 64.4Dedicated to ICU on a rotation basis 6 3.7

Dedicated to ICU only and on arotation basis

52 31.9

Missing 0

Beds per nurse (average)Mean 2.1

SD 0.4Median 2Q1-Q3 1.8-2.2

Missing 0

Beds per nurse (night-time)Mean 2.3

SD 0.5Median 2Q1-Q3 2-2.5

Missing 0

Biomedical devices per bed Mean SD Q1-Q3

Basic ICU monitors (ECG, NIBP, SaO2) 0.7 0.5 0.2-1.1Advanced ICU Monitors with invasive pressure 1.0 0.5 1.0-1.2

Cardiac output monitors 0.4 0.3 0.2-0.5Ventilators 1.4 0.3 1.2-1.5

Syringe pumps 4.3 1.9 3.0-5.0IV. infusion pumps 2.7 1.6 1.6-3.4

Enteral nutrition pumps 1.2 0.4 1.0-1.3

Biomedical equipment in ICU N %

Transoesophageal ECHO (TOE) 42 25.8Basic ultrasound with linear probe 126 77.3

Advanced ultrasound with abdominal probe 106 65.0Blood gas analyser 158 96.9

Haemodialysis/haemofiltration system 129 79.1Transport ventilator 145 89.0

Fiberoscope 163 100.0

Patients admittedMean 315.8

SD 172.6Median 284Q1-Q3 206.6-406.1

Occupancy rate (%)Mean 70.6

SD 14.3Median 70.8Q1-Q3 62.4-78.7

Rotation index (patients/bed)Mean 43.8

SD 16.2Median 41.1Q1-Q3 33.1-53.3

Turnover (hours)Mean 96.2

SD 334.2Median 53.7Q1-Q3 38.5-84.1

Data source: ICU registration form of PROSAFE project.

PROSAFE project

Description of ICUs 22

National report for general ICUs (163 ICUs) - Year 2011Study flow-chart

(1) Patients older than 17 years are considered ADULT.(2) Patients under 17 years old are considered PEDIATRIC patients.(3) Patients evaluated by the GiViTI model of hospital mortality are those with all the variables of the model completed, including the hospitaloutcome.(4) Patients transferred to other ICU are excluded.

PROSAFE project

PARTICIPATING ICUs TOTAL RECRUITED PATIENTSN=210 N=69007

GENERAL ICUs TOTAL RECRUITED PATIENTSN=163 N=50199

PEDIATRIC patientsadmitted in months

with more than 90% ofpatients in status 3 or 4(2)

N=658

ADULT patients admittedin months with morethan 90% of patients

in status 3 or 4(1)

N=47781

Patients admitted inmonths with less than

90% of patients in status3 or 4, or age missing

N=1760

REPORT

1. All patients

Patients admitted inmonths with less than

90% of patients instatus 4 or readmissions

ADULTS PEDIATRICS

N=4271 N=63

ADULT patientsadmitted in months

with more than 90% ofpatients in status 4(1)

N=43510

PEDIATRIC patientsadmitted in months

with more than 90% ofpatients in status 4(2)

N=595

Patients non CS whostayed MORE than

24 hours in ICUN=31381

Patients non CS whostayed LESS than24 hours in ICU

N=11687

Patients with CardiacSurgery (CS)

or LOS missing.

N=442

Patients evaluatedby the MODEL(3)

N=30995

Patients evaluatedby the MODEL(3)

N=11584

Patients evaluated bythe MODEL (PELOD)(4)

N=491REPORT

1. All patients2. Non surgical patients3. Elective surgical

patients4. Emergency surgical

patients

REPORT

1. All patients2. Elective surgical

patients

REPORT

1. All patients

23 Flow-chart

PROSAFE project

24

National report for general ICUs - Year 2011Characteristics on admission - Adult patients

Patients (N): 47781

Sex N %

Male 28194 59.0Female 19587 41.0Missing 0

Age (years) N %

17-45 6380 13.446-65 12208 25.566-75 12583 26.3>75 16610 34.8

Missing 0Mean 66.3

SD 16.6Median 70Q1-Q3 57-79

Min-Max 17-103

Body mass Index (BMI) N %

Underweight 2588 5.5Normal 22530 47.5

Overweight 14777 31.1Obese 7547 15.9

Missing 339

Pregnancy statusFemales (N=19587) N %

Not fertile 10493 53.6Not pregnant/Unknown 8579 43.8

Currently pregnant 64 0.3Post partum 440 2.2

Missing 11

Comorbidities N %

No 7580 15.9Yes 40161 84.1

Missing 40

Comorbidities (top 10) N %

Hypertension 23345 48.9Moderate COPD 7731 16.2

Arrhythmia 7430 15.6Any tumour without metastasis 7138 15.0

Myocardial infarction 5970 12.5NYHA class II-III 5712 12.0

Cerebrovascular disease 5657 11.8Diabetes Type II without insulin tr. 5470 11.5

Peripheral vascular disease 4878 10.2Moderate or severe renal disease 4291 9.0

Missing 40

Stay before ICU (days)Mean 5.0


Missing 53

Source of admission N %

Same hospital 42724 89.5Other hospital 5025 10.5

Missing 32

Ward of admission N %

Medical ward 7272 15.2Surgical ward 22901 48.0

Emergency room 14124 29.6Other ICU 2609 5.5

High dependency care unit 840 1.8Missing 35

Reason for transfer fromOther ICU (N=2609) N %

Specialist expertise 656 25.1Step-up care 507 19.4

Logistical/organizational reasons 1355 51.9Step-down care 91 3.5

Missing 0

Ward of admissionSame hospital (N=42724) N %




Ward of admissionOther hospital (N=5025) N %




Scheduled admission N %

No 36148 75.7Yes 11592 24.3

Missing 41

PROSAFE project

25 Adult patients


Trauma N %

No 41359 86.6Yes 6382 13.4

Multiple trauma 2610 5.5Missing 40

Surgical status N %

Non surgical 22774 47.7Elective surgical 14262 29.9

Emergency surgical 10705 22.4Missing 40

47.7%

29.9%

22.4%

Surgical status

Non surgicalElective surgicalEmergency surgical

Source of admissionSurgical pts. (N=24967) N %

Operating theatre of surgical ward 19711 79.0Operating theatre of emergency room 1530 6.1

Surgical ward 1250 5.0Other 2475 9.9

Missing 1

Surgical interventions (top 10)Elective surgical (N=14262) N %

Gastrointestinal surgery 3669 25.7Orthopaedic surgery 2076 14.6

Nephro/Urological surgery 1727 12.1Neurosurgery 1122 7.9

Thoracic surgery 948 6.6Abdominal vascular surgery 708 5.0

ENT surgery 680 4.8Pancreatic surgery 666 4.7

Gynaecological surgery 645 4.5Hepatic surgery 597 4.2

Missing 0

TimingElective surgical (N=14262) N %

From -7 to -3 days 260 1.8From -2 to -1 days 434 3.0

On ICU admission day 14355 100.7The day after ICU admission 186 1.3

Missing 31

Surgical interventions (top 10)Emergency surgical (N=10705) N %

Gastrointestinal surgery 4674 43.7Neurosurgery 1606 15.0

Orthopaedic surgery 1006 9.4Abdominal vascular surgery 565 5.3

Biliary tract surgery 441 4.1Peripheral vascular surgery 424 4.0Nephro/Urological surgery 373 3.5

Splenectomy 359 3.4Obstetric surgery 320 3.0

Other surgery 295 2.8Missing 0

TimingEmergency surgical (N=10705) N %



Missing 33

Non surgical interventions N %

None 44894 94.0Elective 613 1.3

Emergency 2228 4.7Missing 46

Non surgical interventionsElective (N=613) N %

Interventional endoscopy 167 27.2Interventional neuroradiology 128 20.9

Interventional cardiology 116 18.9Interventional radiology 98 16.0

Missing 104

Non surgical interventionsEmergency (N=2228) N %



Missing 83

PROSAFE project

Adult patients 26


Reason for admission N %

Monitoring/Weaning 19443 40.7Post surgical weaning 8002 16.9

Surgical monitoring 7669 16.2Post interventional weaning 128 0.3

Interventional monitoring 339 0.7Non surgical monitoring 3038 6.4

Missing 267Admission for procedures/treatments 1683 3.5

Intensive Treatment 26495 55.5Only ventilatory support 14312 30.0

Only cardiovascular support 1764 3.7Ventilatory and cardiovascular support 10418 21.8

Missing 1Palliative Sedation 94 0.2

Diagnosis of death/Organ donation 24 0.1Missing 42

0 1 2 3 >3

Number of failures (%)

0

20

40

60

80

100

34.4%

25.1%18.2%

11.3% 11.0%

Failures on admission N %

No 16433 34.4Yes 31348 65.6

A: Respiratory failure 24058 50.4B: Cardiovascular failure 12182 25.5

C: Neurological failure 6500 13.6D: Hepatic failure 463 1.0

E: Renal failure (AKIN) 14869 31.1F: Acute skin failure 34 0.1G: Metabolic failure 9036 18.9

H: Coagulation failure 1070 2.2Missing 0

Failures on admission (top 10) N %

A 7079 14.8E 3114 6.5

ABEG 2469 5.2AB 2388 5.0AC 2207 4.6AE 1943 4.1

ABE 1560 3.3ABCEG 950 2.0

AEG 939 2.0ABC 777 1.6

Missing 0

Respiratory failure N %

None 23051 48.2Only hypoxic failure 7945 16.6

Only hypercapnic failure 1994 4.2Hypoxic-hypercapnic failure 3411 7.1Intubation for airway maint. 11379 23.8

Missing 1

Cardiovascular failure N %

None 35599 74.5Without shock 2396 5.0

Cardiogenic shock 2945 6.2Septic shock 2866 6.0

Haemorrhagic/hypovolemic shock 1844 3.9Hypovolemic shock 715 1.5Anaphylactic shock 38 0.1Neurogenic shock 327 0.7

Other shock 355 0.7Mixed shock 693 1.5

Missing 3

Neurologic failure N %

None 33442 88.4Cerebral coma 2231 5.9

Metabolic coma 639 1.7Postanoxic coma 1360 3.6

Toxic coma 179 0.5Missing or not evaluable 9930

Renal failure (AKIN) N %

None 32819 68.8Mild 7748 16.2

Moderate 3237 6.8Severe 3884 8.1Missing 93

Metabolic failure N %

None 38651 81.1pH <= 7.3, PaCO2 < 45 mmHg 3846 8.1

Base deficit >= 5 mmol/L, lactate >1.5x 5190 10.9Missing 94

PROSAFE project

27 Adult patients


Clinical conditions on admission N %

Respiratory 10927 22.9Acute exacerbation of COPD 3059 6.4

Pleural effusion 2010 4.2ALI (Acute Lung Injury) 1245 2.6

Atelectasis 1058 2.2ARDS 980 2.1

Cardiovascular 10433 21.9Left heart failure with pulmonary edema 2167 4.5

Cardiac arrest 1981 4.2Left heart failure without pulm. edema 1394 2.9

Acute myocardial infarction 1233 2.6Acute severe arrhythmia: tachycardias 1194 2.5

Neurological 6978 14.6Spontaneous Intraparenchymal bleeding 1404 2.9

Cerebral artery stroke 1027 2.2Seizures 1028 2.2

Brain tumour 1007 2.1Metabolic/postanoxic encephalopathy 914 1.9

Gastrointestinal and hepatic 10694 22.4Digestive tract malignancy 3121 6.5

Gastrointestinal perforation 1536 3.2Intestinal occlusion 1454 3.0

Acute bile-duct disease 768 1.6Gastrointestinal bleeding: upper tract 681 1.4

Trauma (anatomical districts) 6382 13.4Pelvis/bone/joint & muscle 3014 6.3

Head 2694 5.6Chest 2262 4.7Spine 1194 2.5

Abdomen 1086 2.3Major vessels injury 228 0.5

Miscellaneous 72 0.2Other 13034 27.3

Metabolic disorder 4368 9.2Nephrourologic disease 2568 5.4

Other disease 1782 3.7Orthopaedic disease 1366 2.9Coagulation disorder 1070 2.2

Post transplantation 312 0.7Renal transplantation 130 0.3Liver transplantation 106 0.2

Infections 10851 22.7Pneumonia 4573 9.6

NON-surgical secondary peritonitis 1135 2.4L.R.T.I. other than pneumonia 799 1.7

NON-surgical urinary tract infection 759 1.6Post-surgical peritonitis 717 1.5

NON-surgical skin/soft tissue infection 488 1.0Cholecystitis/cholangitis 419 0.9

Primary bacteraemia of unknown origin 382 0.8Clinical sepsis 347 0.7

Primary peritonitis 348 0.7Missing 47

Trauma (anatomical districts) N %

Head 2694 5.6Cerebral contusion/laceration 957 2.0

Traumatic Subdural haemathoma 886 1.9Maxillofacial fracture 852 1.8

Traumatic subarachnoid haemorrhage 803 1.7Skull fracture 612 1.3

Spine 1194 2.5Vertebral fracture, without deficit 942 2.0Cervical injury, incomplete deficit 65 0.1

Tetraplegia 67 0.1Chest 2262 4.7

Traum. haemothorax/pneumothorax 981 2.1Other injuries of the chest 880 1.8

Severe lung contusion/laceration 797 1.7Abdomen 1086 2.3

Liver: Moderate-Severe laceration 296 0.6Spleen: Moderate-Severe laceration 254 0.5

Spleen: Massive rupture 228 0.5Pelvis/bone/joint & muscle 3014 6.3

Long bones fracture 2533 5.3Multiple fracture of the pelvis 665 1.4

Very severe or open fracture of the pelvis 140 0.3Major vessels injury 228 0.5

Proximal limbs vessels: transection 91 0.2Neck vessels: dissection/transection 29 0.1

Aorta: rupture/dissection 44 0.1Miscellaneous 72 0.2

Inhalation injury 25 0.1Burns (>30% BSA) 53 0.1

- 0 0.0Missing 47

Infection severity on admission N %

None 36883 77.4Infection with or without SIRS 4899 10.3

SEVERE SEPSIS 2515 5.3SEPTIC SHOCK 3348 7.0

Missing 136

45.5%

23.4%

31.1%

Infection severity on admission

Infection with or without SIRSSEVERE SEPSISSEPTIC SHOCK

Patients infected (N=10762)

PROSAFE project

Adult patients 28

National report for general ICUs - Year 2011Severity scores - Adult patients

3 4 5 6 7 8 9 10 11 12 13 14 15

Glasgow Coma Scale (%)

0

10

20

30

40

50

60

70 On admissionWorst value in the first 24 hours GCS (admission)

Median 15Q1-Q3 11-15

Not evaluable 9870Missing 60

GCS (first 24 hours)Median 15Q1-Q3 11-15


0−4

5−9

10−

14

15−

19

20−

24

25−

29

30−

34

35−

39

40−

44

45−

49

50−

54

55−

59

60−

64

65−

69

70−

74

75−

79

80−

84

85−

89

90−

94

95−

99

100−

104

105−

109

110−

114

115−

119

>=

120

SAPS II (%)

0

5

10

15

SAPSIIMean 37.1

SD 19.9Median 33Q1-Q3 22-48


0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

SOFA (%)

0

5

10

15

20

SOFAMean 5.0



PROSAFE project

29 Adult patients

National report for general ICUs - Year 2011Characteristics during the stay - Adult patients

Complications during the stay N %

No 34478 72.3Yes 13231 27.7

Missing 72

Failures during the stay N %

No 42658 89.3Yes 5123 10.7





Failures during the stay (top 10) N %

B 1452 3.0A 773 1.6E 719 1.5

BE 326 0.7G 334 0.7

AB 265 0.6ABE 136 0.3

C 159 0.3AE 91 0.2

D 87 0.2Missing 0

Respiratory failure occured N %

None 46162 96.8Intubation for airway maint. 384 0.8

Hypoxic failure 1059 2.2Hypercapnic failure 392 0.8

Missing 72

Cardiovascular failure occured N %

None 45094 94.5Cardiogenic shock 843 1.8

Hypovolemic shock 155 0.3Haemorrhagic/hypovolemic shock 296 0.6

Septic shock 1234 2.6Anaphylactic shock 7 0.0Neurogenic shock 121 0.3

Other shock 111 0.2Missing 72

Neurological failure occured N %



Missing 72

Renal failure occured (AKIN) N %

None 45991 96.4Mild 279 0.6



Respiratory 2889 6.1Pleural effusion 990 2.1


ALI (Acute Lung Injury) 409 0.9Pneumothorax/Pneumomediastinum 333 0.7

Cardiovascular 3850 8.1Acute severe arrhythmia: tachycardias 1256 2.6

Cardiac arrest 1179 2.5Left heart failure w/o pulm. edema 400 0.8

Pulmonary edema 390 0.8Acute severe arrhythmia: bradycardias 317 0.7

Neurological 1878 3.9Drowsiness/agitation/delirium 665 1.4

Brain edema 378 0.8Seizures 365 0.8

Intracranial hypertension 281 0.6New ischaemic stroke 176 0.4

Gastrointestinal and hepatic 1339 2.8Gastrointestinal bleeding: upper tract 215 0.5

Anastomotic dehiscence 139 0.3Bowel ischaemia 157 0.3

Gastrointestinal bleeding: lower tract 138 0.3Gastrointestinal perforation 140 0.3

Other 1327 2.8Metabolic disorder 561 1.2

Nephrourologic disease 424 0.9Other disease 303 0.6

Other skin and/or soft tissue pathology 96 0.2Extremity compartment syndrome (severe) 33 0.1

- 0 0.0Delayed liver rupture 4 0.0


L.R.T.I. other than pneumonia 793 1.7NON-surgical urinary tract infection 693 1.5

Primary bacteraemia of unknown origin 362 0.8Catheter-related bacteremia (CR-BSI) 371 0.8

Post-surgical peritonitis 199 0.4Post-surgical skin/soft tissue infection 172 0.4

Upper respiratory tract infection 183 0.4Clinical sepsis 130 0.3

Catheter-related local infection 77 0.2Missing 72

PROSAFE project

Adult patients 30

National report for general ICUs - Year 2011Characteristics during the stay - Adult patients

Infections N %

None 33997 71.3Only on admission 9557 20.0

On admission and during ICU stay 1282 2.7Only during ICU stay 2871 6.0

Missing 74

Maximum severity of infection N %



Missing 245

Severity evolution During the stay

N (R %) NoneInfection with or

without SIRSSEVERESEPSIS

SEPTICSHOCK

TOT

Adm

issi

on

None 33997 (92.5%) 1537 (4.2%) 811 (2.2%) 424 (1.2%) 36769

Infection with or without SIRS - 4210 (86.0%) 494 (10.1%) 190 (3.9%) 4894

SEVERE SEPSIS - - 2129 (84.7%) 384 (15.3%) 2514

SEPTIC SHOCK - - - 3346 (100.0%) 3346

TOT 33997 5748 3434 4344 47523

Ventil. Associat. Pneumonia (VAP) N %

No 46307 97.0Yes 1453 3.0

Missing 21

Incidence of VAP(Pts. with VAP/1000 days of VM pre-VAP)

Estimate 8.9CI (95%) 8.3-9.6

Incidence of VAP(Pts. with VAP/pts. ventilated for 8 days)

Estimate 7.1%CI (95%) 6.6-7.7

Catheter Bacteraemia (CR-BSI) N %

No 47338 99.2Yes 371 0.8

Missing 72

Incidence of CR-BSI(Pts. with CR-BSI/1000 days of CVC pre-CR-BSI)

Estimate 1.5CI (95%) 1.3-1.7

Incidence of CR-BSI(Pts. with CR-BSI/pts. catheterized for 12 days)

Estimate 1.8%CI (95%) 1.5-2.0

PROSAFE project

31 Adult patients

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PROSAFE project

Adult patients 32

National report for general ICUs - Year 2011Process indicators - Adult patients

Length (days)Invasive ventilation (N=33925) N % Mean SD Median Q1-Q3 Missing

Due to pulmonary failure 11479 33.8 8.4 12.7 4 1-10 9For airway mainteinance 11302 33.3 6.4 10.3 2 1-8 8

In weaning 7871 23.2 0.4 0.5 0 0-1 0Not evaluable 3294 9.7 4.9 10.4 2 1-4 20

Reintubation within 48 hours 462 1.4 8.2 11.4 5 2-10 1

Non invasive ventilation (N=6613) N %

Non invasive ventilation only 3394 51.3Non invasive ventilation failed 1025 15.5

For weaning 1958 29.6Other 236 3.6

Missing 0

Tracheostomy (N=5555) N %

Surgical 1456 26.2Ciaglia 451 8.1

Monodil. Ciaglia 1650 29.7Fantoni 332 6.0Griggs 643 11.6

Percutwist 754 13.6Other Kind 265 4.8

Missing 4

Tracheostomy - Days after the beginning of inv. vent.N 5259

Mean 6.9SD 6.8

Median 6Q1-Q3 1-10

Invasive monitoring of C.O.(N=1928)

N %

Swan Ganz 447 23.2PICCO 1040 53.9LIDCO 17 0.9

Vigileo-PRAM 416 21.6Other 7 0.4

Missing 1

SDD (N=878) N %

Topical 411 46.8Topical and systemic 467 53.2

Missing 0

Antibiotic therapyPts. infected in ICU only (N=2871) N %

Only empirical 807 29.8Only targeted 1235 45.6

Targeted after empirical 500 18.5Other 167 6.2

Missing 162

Surgical interventions N %

No 45690 95.7Yes 2036 4.3

Missing 55

Number of surgical interventions N %

0 45690 95.71 1628 3.42 294 0.63 68 0.1

>3 46 0.1Missing 55

Surgical interventionsDays from admission

Mean 9.7SD 11.2

Median 6Q1-Q3 3-12

Missing 0

Surgical interventions (top 10) N %


Neurosurgery 293 0.6ENT surgery 193 0.4

Thoracic surgery 121 0.3Other surgery 144 0.3

Nephro/Urological surgery 78 0.2Maxillo-Facial surgery 114 0.2

Plastic surgery 81 0.2Pancreatic surgery 34 0.1

Missing 55


No 46891 98.3Yes 828 1.7

Missing 62

Non surgical interventionsDays from admission

Mean 11.6SD 14.0

Median 7Q1-Q3 3-14

Missing 22


Interventional endoscopy 523 1.1Interventional radiology 200 0.4

Interventional cardiology 157 0.3Interventional neuroradiology 61 0.1

Missing 62

PROSAFE project

33 Adult patients

National report for general ICUs - Year 2011Outcome indicators - Adult patients

ICU outcome N %

Dead 8523 17.9Transferred to same hospital 34706 72.7Transferred to other hospital 3573 7.5

Discharged home 799 1.7Disch. terminally ill 108 0.2

Missing 72

Transferred to (N=38279) N %

Ward 32632 85.2Other ICU 2650 6.9

High dependency care unit 2375 6.2Rehabilitation 489 1.3

Day hospital or Long-term care 133 0.3Missing 0

Reason of transfer toOther ICU (N=2686) N %



Missing 0

Transferred toSame hospital (N=34706) N %

Ward 31285 90.1Other ICU 1207 3.5



Transferred toOther hospital (N=3573) N %

Ward 1347 37.7Other ICU 1443 40.4



ICU mortality N %

Alive 39078 81.9Dead 8631 18.1

Missing 72

Timing of ICU mortality (N=8631) N %

Daytime (08:00AM - 07:59PM) 5643 65.4Nigthtime (08:00PM - 07:59AM) 2986 34.6

Weekdays (Monday - Friday) 6458 74.8Weekend (Saturday - Sunday) 2173 25.2

Missing 2

Brain death assessment° (N=8631) N %

Yes, with organ donation 278 6.2Yes, without organ donation 328 7.3

No 3889 86.5Missing 4136

Organ/Tissue removal° (N=278) N %

No removal 11 11.7Only organ removal 0 0.0Only tissue removal 0 0.0

Organ and tissue removal 83 88.3Missing 184

Hospital mortality ° * N %

Dead 5491 23.4Transf. to other acute-care hospital 1939 8.3

Transf. to other type of hosp. stay 2739 11.7Nursing home 450 1.9

Voluntary discharge 180 0.8Discharged home 12633 53.9

Missing 20078

To other type of H stay° * (N=2739) N %

Rehabilitation in the same institute 502 18.3Rehabilitation in other institute 1576 57.5DH/long-term care, same inst. 219 8.0DH/long-term care, other inst. 442 16.1

Missing 0

Disch. terminally ill ° * (N=17941) N %

Yes 282 1.6No 17654 98.4

Missing 5

Hospital mortality * N %

Alive 32516 75.0Dead 10814 25.0

Missing 180

Timing of hosp. mortality *(N=10814)

N %

In ICU 7732 71.5Within 24 hours after ICU 187 1.7Within 48 hours after ICU 384 3.6Within 72 hours after ICU 563 5.2Within 96 hours after ICU 730 6.8

After more than 96 hours after ICU 2350 21.7Missing 0

Timing of hosp. mortality (days from ICU disch.) *Discharged alive from ICU (N=3082)

Mean 17.6SD 24.9

Median 10Q1-Q3 4-22

Missing 2° Variables collected since June 2011.* Statistics computed on patients admitted in months with more than 90% of patients in status 4 (readmissions excluded) (N=43510).

PROSAFE project

Adult patients 34

National report for general ICUs - Year 2011Outcome indicators - Adult patients

Last hospital mortality * N %

Alive 32264 74.5Dead 11017 25.5

Missing 229

Readmission from ward N %

No 46447 97.3Yes 1275 2.7

Missing 59

Number of readmissions (N=1275) N %

1 1193 93.62 76 6.0

>2 6 0.5Missing 0

Timing of readmission (N=1275) N %

Within 48 hours 313 25.8Within 72 hours 418 34.5Within 96 hours 511 42.2

After 96 hours 701 57.8Missing 63

Timing readmission (days)N 1212

Mean 10.1SD 15.3

Median 5.1Q1-Q3 2-12.1

ICU stay (days)Mean 6.4


Missing 66

ICU stay (days)Alive (N=39078)

Mean 5.9SD 10.0

Median 2Q1-Q3 1-6

Missing 3

ICU stay (days)Dead (N=8631)

Mean 8.5SD 13.6

Median 3Q1-Q3 1-10

Missing 0

Stay after ICU (days) *Alive (N=35736)

Mean 13.9SD 19.5

Median 9Q1-Q3 4-17

Missing 145

Hospital stay (days) *Mean 21.4

SD 24.2Median 15Q1-Q3 8-27

Missing 192

Hospital stay (days) *Alive (N=32516)

Mean 22.6SD 24.0

Median 16Q1-Q3 9-28

Missing 14

Hospital stay (days) *Dead (N=10814)

Mean 18.0SD 24.5

Median 10Q1-Q3 3-24

Missing 4

* Statistics computed on patients admitted in months with more than 90% of patients in status 4 (readmissions excluded) (N=43510).

PROSAFE project

35 Adult patients

National report for general ICUs - Year 2011Analysis of hospital mortality: forest plot (IC 95%)Predictive model: GiViTI 2011

●●

●●

●●●●●●●

●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●

●●●

●●

●●

●

−1.5 −1.0 −0.5 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5

Mortality greater than expectedMortality lower than expected

PROSAFE project

Forest plot 36

National report for general ICUs - Year 2011Characteristics on admission - Adult patients with LOS>=24 hours evaluated in the GiViTI model

Patients (N): 30995

Sex N %


Age (years) N %

17-45 4276 13.846-65 7822 25.266-75 8025 25.9>75 10872 35.1

Missing 0Mean 66.1

SD 16.8Median 70Q1-Q3 57-79

Min-Max 17-103




Missing 0




Missing 0

Comorbidities N %

No 5075 16.4Yes 25920 83.6

Missing 0


Hypertension 14985 48.3Moderate COPD 5165 16.7

Arrhythmia 5000 16.1Any tumour without metastasis 3991 12.9

NYHA class II-III 3921 12.7Cerebrovascular disease 3833 12.4

Myocardial infarction 3819 12.3Diabetes Type II without insulin tr. 3610 11.6

Peripheral vascular disease 3052 9.8Moderate or severe renal disease 2951 9.5

Missing 0



Missing 0



Missing 0








Missing 0










No 25711 83.0Yes 5284 17.0

Missing 0

PROSAFE project

37 Adult patients (LOS>=24 hours)


Trauma N %

No 26356 85.0Yes 4639 15.0


Surgical status N %



54.8%

21.4%

23.8%

Surgical status





Missing 0



Nephro/Urological surgery 787 11.9Thoracic surgery 484 7.3

Neurosurgery 453 6.8Abdominal vascular surgery 343 5.2

ENT surgery 325 4.9Gynaecological surgery 291 4.4

Pancreatic surgery 281 4.2Hepatic surgery 276 4.2

Missing 0




Missing 11




Biliary tract surgery 298 4.0Peripheral vascular surgery 270 3.7

Splenectomy 273 3.7Nephro/Urological surgery 249 3.4

Obstetric surgery 200 2.7Other surgery 196 2.7

Missing 0




Missing 13


None 29068 93.8Elective 348 1.1



Interventional endoscopy 103 29.6Interventional cardiology 77 22.1

Interventional neuroradiology 65 18.7Interventional radiology 64 18.4

Missing 39




Missing 47

PROSAFE project

Adult patients (LOS>=24 hours) 38











0 1 2 3 >3


0

20

40

60

80

100

25.9% 27.8%21.9%

13.3% 11.0%


No 8020 25.9Yes 22975 74.1






A 5644 18.2AB 1930 6.2AC 1764 5.7

E 1705 5.5ABEG 1636 5.3

AE 1565 5.0ABE 1237 4.0AEG 745 2.4ABC 594 1.9

B 563 1.8Missing 0




Missing 0






Missing 0






None 20882 67.4Mild 5558 17.9



None 24880 80.3pH <= 7.3, PaCO2 < 45 mmHg 2684 8.7


PROSAFE project








Cardiac arrest 1354 4.4Left heart failure without pulm. edema 1003 3.2Acute severe arrhythmia: tachycardias 863 2.8

Acute myocardial infarction 840 2.7Neurological 4865 15.7

Spontaneous Intraparenchymal bleeding 1055 3.4Cerebral artery stroke 760 2.5

Seizures 771 2.5Metabolic/postanoxic encephalopathy 717 2.3

Spontaneous Subarachnoid haemorrhage 546 1.8Gastrointestinal and hepatic 6441 20.8

Digestive tract malignancy 1655 5.3Gastrointestinal perforation 1084 3.5

Intestinal occlusion 940 3.0Gastrointestinal bleeding: upper tract 450 1.5

Acute bile-duct disease 462 1.5Trauma (anatomical districts) 4639 15.0

Head 2088 6.7Pelvis/bone/joint & muscle 2075 6.7

Chest 1817 5.9Spine 959 3.1




Other disease 960 3.1Coagulation disorder 707 2.3Orthopaedic disease 659 2.1

Post transplantation 186 0.6Liver transplantation 72 0.2

Renal transplantation 69 0.2Infections 8442 27.2Pneumonia 3810 12.3

NON-surgical secondary peritonitis 873 2.8L.R.T.I. other than pneumonia 693 2.2

NON-surgical urinary tract infection 624 2.0Post-surgical peritonitis 484 1.6

NON-surgical skin/soft tissue infection 379 1.2Cholecystitis/cholangitis 302 1.0

Primary bacteraemia of unknown origin 288 0.9Primary peritonitis 246 0.8

Clinical sepsis 230 0.7Missing 0



Maxillofacial fracture 674 2.2Traumatic Subdural haemathoma 657 2.1







Spleen: Massive rupture 175 0.6Pelvis/bone/joint & muscle 2075 6.7



Proximal limbs vessels: transection 61 0.2Neck vessels: dissection/transection 23 0.1

Aorta: rupture/dissection 20 0.1Miscellaneous 55 0.2


- 0 0.0Missing 0




Missing 0

45.4%

24.7%

29.9%




PROSAFE project


National report for general ICUs - Year 2011Severity scores - Adult patients with LOS>=24 hours evaluated in the GiViTI model

3 4 5 6 7 8 9 10 11 12 13 14 15


0

10

20

30

40

50

60

70

On admissionWorst value in the first 24 hours GCS (admission)





0−4

5−9

10−

14

15−

19

20−

24

25−

29

30−

34

35−

39

40−

44

45−

49

50−

54

55−

59

60−

64

65−

69

70−

74

75−

79

80−

84

85−

89

90−

94

95−

99

100−

104

105−

109

110−

114

115−

119

>=

120

SAPS II (%)

0

5

10

15

SAPSIIMean 38.9

SD 18.3Median 36Q1-Q3 25-50


0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

SOFA (%)

0

5

10

15

SOFAMean 5.4



PROSAFE project


National report for general ICUs - Year 2011Characteristics during the stay - Adult patients with LOS>=24 hours evaluated in the GiViTI model


No 20799 67.1Yes 10195 32.9

Missing 1


No 27024 87.2Yes 3971 12.8






B 1132 3.7A 626 2.0E 560 1.8

BE 261 0.8AB 217 0.7

G 224 0.7ABE 119 0.4

C 110 0.4AE 75 0.2

D 72 0.2Missing 0




Missing 1









Missing 1


None 29653 95.7Mild 222 0.7





ALI (Acute Lung Injury) 341 1.1Pneumothorax/Pneumomediastinum 289 0.9



Pulmonary edema 288 0.9Acute ischaemia 171 0.6Neurological 1508 4.9

Drowsiness/agitation/delirium 536 1.7Brain edema 304 1.0

Seizures 312 1.0Intracranial hypertension 215 0.7

New ischaemic stroke 143 0.5Gastrointestinal and hepatic 1063 3.4

Gastrointestinal bleeding: upper tract 162 0.5Anastomotic dehiscence 113 0.4

Bowel ischaemia 121 0.4Gastrointestinal bleeding: lower tract 116 0.4

Gastrointestinal perforation 121 0.4Other 1012 3.3


Other disease 233 0.8Other skin and/or soft tissue pathology 82 0.3

Extremity compartment syndrome (severe) 29 0.1- 0 0.0

Delayed liver rupture 4 0.0Infections 3555 11.5Pneumonia 1435 4.6



Post-surgical peritonitis 157 0.5Post-surgical skin/soft tissue infection 146 0.5

Upper respiratory tract infection 155 0.5Clinical sepsis 107 0.3

F.U.O. fever of unknown origin 95 0.3Missing 1

PROSAFE project


National report for general ICUs - Year 2011Characteristics during the stay - Adult patients with LOS>=24 hours evaluated in the GiViTI model

Infections N %



Missing 1




Missing 91




SEPTICSHOCK

TOT

Adm

issi

on

None 20084 (89.4%) 1294 (5.8%) 710 (3.2%) 375 (1.7%) 22463


SEVERE SEPSIS - - 1773 (85.0%) 313 (15.0%) 2086

SEPTIC SHOCK - - - 2523 (100.0%) 2523

TOT 20084 4534 2912 3374 30904


No 29747 96.0Yes 1247 4.0

Missing 1


Estimate 8.8CI (95%) 8.1-9.5


Estimate 7.0%CI (95%) 6.5-7.6


No 30690 99.0Yes 304 1.0

Missing 1


Estimate 1.4CI (95%) 1.2-1.6


Estimate 1.7%CI (95%) 1.4-2.0

PROSAFE project


Use

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PROSAFE project


National report for general ICUs - Year 2011Process indicators - Adult patients with LOS>=24 hours evaluated in the GiViTI model




Reintubation within 48 hours 406 1.8 8.3 11.2 5 2-10.75 0




Missing 0





Missing 1


Mean 7.1SD 6.8

Median 6Q1-Q3 1-11

Invasive monitoring of C.O.(N=1473)

N %



Missing 0

SDD (N=725) N %


Missing 0




Missing 140


No 29224 94.3Yes 1771 5.7

Missing 0


0 29224 94.31 1419 4.62 254 0.83 59 0.2

>3 39 0.1Missing 0


Mean 9.7SD 11.2

Median 6Q1-Q3 3-12

Missing 0



Neurosurgery 241 0.8ENT surgery 177 0.6

Other surgery 118 0.4Maxillo-Facial surgery 107 0.3

Thoracic surgery 105 0.3Nephro/Urological surgery 68 0.2

Plastic surgery 77 0.2Peripheral vascular surgery 50 0.2

Missing 0


No 30277 97.7Yes 718 2.3

Missing 0


Mean 11.4SD 14.0

Median 7Q1-Q3 3-14

Missing 14




Missing 0

PROSAFE project


National report for general ICUs - Year 2011Outcome indicators - Adult patients with LOS>=24 hours evaluated in the GiViTI model

ICU outcome N %



Missing 0


Ward 20661 83.3Other ICU 1826 7.4






Missing 0


Ward 19584 88.6Other ICU 837 3.8




Ward 1077 39.7Other ICU 989 36.5



ICU mortality N %

Alive 25420 82.0Dead 5575 18.0

Missing 0




Missing 0



No 2452 85.7Missing 2715




Hospital mortality ° N %




Missing 14363

To other type of H stay° (N=2218) N %


Missing 0

Disch. terminally ill ° (N=12473) N %

Yes 218 1.7No 12255 98.3

Missing 0

Hospital mortality N %

Alive 22867 73.8Dead 8128 26.2

Missing 0

Timing of hosp. mortality (N=8128) N %



Timing of hosp. mortality (days from ICU disch.)Discharged alive from ICU (N=2553)

Mean 17.7SD 24.4

Median 10Q1-Q3 4-23

Missing 0

° Variables collected since June 2011.

PROSAFE project


National report for general ICUs - Year 2011Outcome indicators - Adult patients with LOS>=24 hours evaluated in the GiViTI model

Last hospital mortality N %

Alive 22685 73.3Dead 8274 26.7

Missing 36



Missing 0


Mean 7.6SD 11.0

Median 4Q1-Q3 2-9

Missing 0


Mean 11.0SD 15.0

Median 6Q1-Q3 3-13

Missing 0

Stay after ICU (days)Alive (N=25420)

Mean 14.7SD 20.4

Median 9Q1-Q3 4-18

Missing 7

Hospital stay (days)Mean 24.0

SD 25.3Median 17Q1-Q3 9-30

Missing 7

Hospital stay (days)Alive (N=22867)

Mean 25.1SD 25.3


Missing 7

Hospital stay (days)Dead (N=8128)

Mean 21.0SD 25.2

Median 13Q1-Q3 5-28

Missing 0

PROSAFE project


PROSAFE project

48

National report for general ICUs - Year 2011Characteristics on admission - Adult non surgical patients with LOS>=24 hours evaluated in the GiViTI model

Patients (N): 16997

Sex N %


Age (years) N %

17-45 2347 13.846-65 4431 26.166-75 4396 25.9>75 5823 34.3

Missing 0Mean 65.8

SD 16.7Median 70Q1-Q3 56-78

Min-Max 17-102




Missing 0




Missing 0

Comorbidities N %

No 2769 16.3Yes 14228 83.7

Missing 0


Hypertension 7951 46.8Arrhythmia 2989 17.6

Moderate COPD 2976 17.5NYHA class II-III 2513 14.8


Myocardial infarction 2115 12.4Severe COPD 2034 12.0

Moderate or severe renal disease 1811 10.7Peripheral vascular disease 1520 8.9

Missing 0



Missing 0



Missing 0








Missing 0










No 16921 99.6Yes 76 0.4

Missing 0

PROSAFE project

49 Non surgical (LOS>=24 hours)


Trauma N %

No 14753 86.8Yes 2244 13.2


Surgical status N %



100.0%

0.0%0.0%

Surgical status





Missing 0


- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0

Missing 0




Missing 0


- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0

Missing 0




Missing 0


None 15623 91.9Elective 223 1.3



Interventional cardiology 72 32.3Interventional endoscopy 64 28.7

Interventional neuroradiology 48 21.5Interventional radiology 40 17.9

Missing 0



Interventional radiology 185 16.1Interventional neuroradiology 146 12.7

Missing 0

PROSAFE project

Non surgical (LOS>=24 hours) 50











0 1 2 3 >3


0

20

40

60

80

100

13.7%

28.4% 27.0%

16.9%14.1%


No 2327 13.7Yes 14670 86.3






A 3790 22.3AC 1417 8.3AB 1131 6.7AE 1140 6.7

ABEG 997 5.9ABE 800 4.7AEG 541 3.2ABC 444 2.6

E 437 2.6ABCEG 407 2.4Missing 0




Missing 0






Missing 0






None 10804 63.6Mild 3217 18.9



None 13053 76.8pH <= 7.3, PaCO2 < 45 mmHg 1768 10.4


PROSAFE project






ARDS 680 4.0Atelectasis 609 3.6


Cardiac arrest 1228 7.2Left heart failure without pulm. edema 826 4.9

Acute myocardial infarction 758 4.5Acute severe arrhythmia: tachycardias 648 3.8

Neurological 3463 20.4Spontaneous Intraparenchymal bleeding 711 4.2


Cerebral artery stroke 667 3.9Spontaneous Subarachnoid haemorrhage 322 1.9

Gastrointestinal and hepatic 1160 6.8Gastrointestinal bleeding: upper tract 255 1.5

Acute pancreatitis 205 1.2Liver Dysfunction Syndrome 155 0.9

Ascites 143 0.8Acute bile-duct disease 83 0.5

Trauma (anatomical districts) 2244 13.2Head 1279 7.5Chest 1061 6.2

Pelvis/bone/joint & muscle 691 4.1Spine 545 3.2



Metabolic disorder 2097 12.3Acute intoxication 604 3.6


Coagulation disorder 407 2.4Post transplantation 87 0.5

Renal transplantation 37 0.2Bone marrow transplantation 15 0.1



Primary bacteraemia of unknown origin 250 1.5NON-surgical CNS infection 212 1.2

NON-surgical skin/soft tissue infection 211 1.2Clinical sepsis 181 1.1

Cholecystitis/cholangitis 133 0.8Gastroenteritis 111 0.7

Upper respiratory tract infection 123 0.7Missing 0



Traumatic subarachnoid haemorrhage 437 2.6Maxillofacial fracture 393 2.3

Traumatic Subdural haemathoma 336 2.0Skull fracture 269 1.6






Minor injuries of the abdomen 86 0.5Pelvis/bone/joint & muscle 691 4.1



Major abdominal vessels: transection 11 0.1Proximal limbs vessels: transection 11 0.1

Neck vessels: dissection/transection 6 0.0Miscellaneous 25 0.1


- 0 0.0Missing 0




Missing 0

47.4%

26.3%

26.3%




PROSAFE project


National report for general ICUs - Year 2011Severity scores - Adult non surgical patients with LOS>=24 hours evaluated in the GiViTI model

3 4 5 6 7 8 9 10 11 12 13 14 15


0

10

20

30

40

50On admissionWorst value in the first 24 hours GCS (admission)

Median 13Q1-Q3 8-15




0−4

5−9

10−

14

15−

19

20−

24

25−

29

30−

34

35−

39

40−

44

45−

49

50−

54

55−

59

60−

64

65−

69

70−

74

75−

79

80−

84

85−

89

90−

94

95−

99

100−

104

105−

109

110−

114

115−

119

>=

120

SAPS II (%)

0

5

10

15

SAPSIIMean 43.7

SD 18.8Median 42Q1-Q3 30-56


0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

SOFA (%)

0

5

10

15

SOFAMean 6.3



PROSAFE project


National report for general ICUs - Year 2011Characteristics during the stay - Adult non surgical patients with LOS>=24 hours evaluated in the GiViTI model


No 10654 62.7Yes 6342 37.3

Missing 1


No 14540 85.5Yes 2457 14.5






B 746 4.4A 343 2.0E 336 2.0

BE 166 1.0AB 135 0.8

G 144 0.8C 89 0.5

ABE 60 0.4AE 44 0.3AC 30 0.2

Missing 0




Missing 1









Missing 1


None 16181 95.2Mild 119 0.7




ARDS 340 2.0Atelectasis 302 1.8

Pneumothorax/Pneumomediastinum 200 1.2ALI (Acute Lung Injury) 189 1.1



Pulmonary edema 203 1.2Acute severe arrhythmia: bradycardias 143 0.8


Seizures 235 1.4Brain edema 186 1.1


Gastrointestinal and hepatic 472 2.8Gastrointestinal bleeding: upper tract 109 0.6Gastrointestinal bleeding: lower tract 60 0.4

Liver Dysfunction Syndrome 66 0.4Paralytic Ileous 66 0.4

Acute bile-duct disease 29 0.2Other 580 3.4


Other disease 117 0.7Other skin and/or soft tissue pathology 38 0.2

- 0 0.0Delayed liver rupture 1 0.0

Delayed spleen rupture 5 0.0Infections 2304 13.6Pneumonia 989 5.8



Upper respiratory tract infection 107 0.6Catheter-related local infection 48 0.3

Clinical sepsis 56 0.3F.U.O. fever of unknown origin 54 0.3

Gastroenteritis 35 0.2Missing 1

PROSAFE project


National report for general ICUs - Year 2011Characteristics during the stay - Adult non surgical patients with LOS>=24 hours evaluated in the GiViTI model

Infections N %



Missing 1




Missing 50




SEPTICSHOCK

TOT

Adm

issi

on

None 9608 (86.7%) 812 (7.3%) 456 (4.1%) 201 (1.8%) 11077


SEVERE SEPSIS - - 1309 (84.7%) 236 (15.3%) 1545

SEPTIC SHOCK - - - 1544 (100.0%) 1544

TOT 9608 3126 2116 2097 16947


No 16120 94.8Yes 876 5.2

Missing 1


Estimate 8.8CI (95%) 8.0-9.6


Estimate 7.0%CI (95%) 6.4-7.7


No 16808 98.9Yes 188 1.1

Missing 1


Estimate 1.3CI (95%) 1.1-1.6


Estimate 1.6%CI (95%) 1.3-1.9

PROSAFE project


Use

On

adm

issi

onO

ndi

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(Mis

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N%

N%

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Med

ian

Q1-

Q3

Mis

sing

Med

ian

Q1-

Q3

Mis

sing

Pro

cedu

res

(ant

ibio

tics

excl

uded

)16

414

96.6

Inva

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vent

ilatio

n12

504

73.6

6797

4030

4417

.95

2-11

10

0-0

0N

onin

vasi

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3752

22.1

725

4.3

723

4.3

21-

40

00-

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Trac

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7419

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54.

425

8415

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0.4

60

160.

14

1-7

02

1-6

0C

entra

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Cat

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405

78.9

4120

24.2

9606

56.5

73-

130

00-

00

Art

eria

lCat

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r12

613

74.2

3049

17.9

3660

21.5

63-

120

00-

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Vaso

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6820

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2211

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968.

83

2-6

00

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1892

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537

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947

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42-

90

00-

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IAB

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848

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Inva

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94.

995

0.6

176

15

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148

0.9

310.

247

0.3

63-

110

00-

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Tem

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119

0.7

500.

335

0.2

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Vent

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0.2

330.

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0.5

270.

237

0.2

95-

160

10-

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Hae

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965

5.7

990.

623

01.

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2-9

01

0-4

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82.

912

30.

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340.

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0.2

104-

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10-

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Hep

atic

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05

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P(in

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01.

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nter

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on90

4053

.214

238.

452

6331

73-

150

11-

20

Par

ente

raln

utrit

ion

4988

29.3

822

4.8

2124

12.5

53-

100

10-

20

SD

D(T

opic

al,T

opic

alan

dsy

stem

ic)

504

3.0

Pat

ient

rest

rain

t90

25.

3Va

cuum

ther

apy

240.

1A

ntib

iotic

s12

112

71.3

Ant

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tics

fors

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calp

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ylax

is43

92.

618

81.

121

21.

23

1-7

00

0-3

0A

ntib

iotic

sfo

rmed

ical

prop

hyla

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5371

31.6

1544

9.1

2935

17.3

42-

80

00-

00

Em

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alan

tibio

ticth

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y52

8631

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4610

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5515

53-

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00-

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antib

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ther

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3439

20.2

686

420

6212

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5-15

15

2-9

1

Nat

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PROSAFE project


National report for general ICUs - Year 2011Process indicators - Adult non surgical patients with LOS>=24 hours evaluated in the GiViTI model




Reintubation within 48 hours 226 1.8 8.6 11.2 6 2-10.75 0




Missing 0





Missing 1


Mean 7.2SD 6.9

Median 6Q1-Q3 1-11

Invasive monitoring of C.O. (N=839) N %



Missing 0

SDD (N=504) N %


Missing 0




Missing 86


No 16007 94.2Yes 990 5.8

Missing 0


0 16007 94.21 848 5.02 115 0.73 19 0.1

>3 8 0.0Missing 0


Mean 9.3SD 10.9

Median 6Q1-Q3 3-11

Missing 0


Orthopaedic surgery 315 1.9Gastrointestinal surgery 213 1.3

ENT surgery 128 0.8Neurosurgery 132 0.8

Thoracic surgery 81 0.5Maxillo-Facial surgery 63 0.4

Other surgery 55 0.3Nephro/Urological surgery 34 0.2

Peripheral vascular surgery 26 0.2Biliary tract surgery 30 0.2

Missing 0


No 16468 96.9Yes 529 3.1

Missing 0


Mean 11.4SD 13.3

Median 7Q1-Q3 3-14

Missing 8


Interventional endoscopy 339 2.0Interventional cardiology 124 0.7Interventional radiology 104 0.6

Interventional neuroradiology 25 0.1Missing 0

PROSAFE project


National report for general ICUs - Year 2011Outcome indicators - Adult non surgical patients with LOS>=24 hours evaluated in the GiViTI model

ICU outcome N %



Missing 0


Ward 9444 76.2Other ICU 1376 11.1






Missing 0


Ward 8562 83.7Other ICU 634 6.2




Ward 882 40.9Other ICU 742 34.4



ICU mortality N %

Alive 12865 75.7Dead 4132 24.3

Missing 0




Missing 0



No 1795 85.9Missing 2042








Missing 8108



Missing 0


Yes 123 2.0No 5977 98.0

Missing 0


Alive 11446 67.3Dead 5551 32.7

Missing 0





Mean 16.6SD 25.6

Median 8Q1-Q3 3-21

Missing 0


PROSAFE project


National report for general ICUs - Year 2011Outcome indicators - Adult non surgical patients with LOS>=24 hours evaluated in the GiViTI model


Alive 11303 66.6Dead 5668 33.4

Missing 26



Missing 0


Mean 9.6SD 12.1

Median 5Q1-Q3 3-12

Missing 0


Mean 11.1SD 15.5

Median 6Q1-Q3 3-13

Missing 0


Mean 13.6SD 20.3

Median 8Q1-Q3 2-17

Missing 5


SD 25.6Median 16Q1-Q3 8-30

Missing 5


Mean 25.0SD 25.8


Missing 5


Mean 19.7SD 25.0

Median 12Q1-Q3 5-25

Missing 0

PROSAFE project


PROSAFE project

60

National report for general ICUs - Year 2011Characteristics on admission - Adult elective surgical patients with LOS>=24 hours evaluated in the GiViTI model

Patients (N): 6634

Sex N %


Age (years) N %

17-45 493 7.446-65 1711 25.866-75 2024 30.5>75 2406 36.3

Missing 0Mean 68.8

SD 14.0Median 71Q1-Q3 62-79

Min-Max 17-103




Missing 0




Missing 0

Comorbidities N %

No 539 8.1Yes 6095 91.9

Missing 0


Hypertension 3632 54.7Any tumour without metastasis 2078 31.3

Moderate COPD 1253 18.9Myocardial infarction 1009 15.2

Arrhythmia 970 14.6Diabetes Type II without insulin tr. 850 12.8

Peripheral vascular disease 815 12.3Metastatic cancer 793 12.0NYHA class II-III 760 11.5

Cerebrovascular disease 667 10.1Missing 0



Missing 0



Missing 0








Missing 0










No 1435 21.6Yes 5199 78.4

Missing 0

PROSAFE project

61 Elective surgical (LOS>=24 hours)


Trauma N %

No 6050 91.2Yes 584 8.8


Surgical status N %



0.0%

100.0%

0.0%

Surgical status





Missing 0



Nephro/Urological surgery 787 11.9Thoracic surgery 484 7.3

Neurosurgery 453 6.8Abdominal vascular surgery 343 5.2

ENT surgery 325 4.9Gynaecological surgery 291 4.4

Pancreatic surgery 281 4.2Hepatic surgery 276 4.2

Missing 0




Missing 11


- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0

Missing 0




Missing 0


None 6524 98.3Elective 71 1.1




Interventional neuroradiology 7 9.9Interventional cardiology 3 4.2

Missing 30


Interventional radiology 10 25.6Interventional cardiology 8 20.5Interventional endoscopy 8 20.5


PROSAFE project

Elective surgical (LOS>=24 hours) 62











0 1 2 3 >3


0

20

40

60

80

100

59.1%

26.4%

8.8%3.4% 2.3%


No 3921 59.1Yes 2713 40.9






E 795 12.0A 623 9.4

AB 174 2.6B 147 2.2

AE 139 2.1EG 123 1.9

G 124 1.9ABEG 83 1.3

ABE 80 1.2BE 53 0.8

Missing 0




Missing 0






Missing 0






None 5196 78.3Mild 957 14.4



None 6085 91.7pH <= 7.3, PaCO2 < 45 mmHg 270 4.1


PROSAFE project




Respiratory 950 14.3Lung cancer 331 5.0

Upper respiratory tract disease 130 2.0Pleural effusion 134 2.0

Atelectasis 112 1.7Acute exacerbation of COPD 81 1.2

Cardiovascular 1008 15.2Non-ruptured aneurysm 279 4.2

Peripheral vascular disease 241 3.6Left heart failure without pulm. edema 90 1.4Acute severe arrhythmia: tachycardias 90 1.4

Cardiac arrest 64 1.0Neurological 526 7.9

Brain tumour 317 4.8Cerebral artery stroke 37 0.6

Seizures 43 0.6Cerebral Aneurysm 34 0.5

CNS degenerative disease 26 0.4Gastrointestinal and hepatic 2203 33.2

Digestive tract malignancy 1319 19.9Pancreatic malignancy 254 3.8

Hepatic malignancy 232 3.5Acute bile-duct disease 159 2.4

Intestinal occlusion 92 1.4Trauma (anatomical districts) 584 8.8

Pelvis/bone/joint & muscle 525 7.9Chest 57 0.9Head 56 0.8Spine 48 0.7



Nephrourologic disease 710 10.7Orthopaedic disease 456 6.9

Other disease 402 6.1ENT/maxillofacial disease 398 6.0

Metabolic disorder 247 3.7Post transplantation 31 0.5

Liver transplantation 19 0.3Renal transplantation 6 0.1


Post-surgical peritonitis 33 0.5NON-surgical skin/soft tissue infection 36 0.5

Cholecystitis/cholangitis 25 0.4NON-surgical secondary peritonitis 29 0.4

L.R.T.I. other than pneumonia 23 0.3Post-surgical skin/soft tissue infection 19 0.3

NON-surgical urinary tract infection 18 0.3Primary bacteraemia of unknown origin 10 0.2

Post-surgical bone and joint infection 14 0.2Missing 0


Head 56 0.8Maxillofacial fracture 28 0.4

Cerebral contusion/laceration 17 0.3Traumatic Subdural haemathoma 9 0.1

Traumatic Intraparenchimal bleeding 5 0.1Traumatic subarachnoid haemorrhage 9 0.1


Paraplegia 4 0.1Chest 57 0.9

Other injuries of the chest 24 0.4Traum. haemothorax/pneumothorax 21 0.3


Spleen: Massive rupture 4 0.1Minor injuries of the abdomen 7 0.1

- 0 0.0Pelvis/bone/joint & muscle 525 7.9


Massive crush/amputation 6 0.1Major vessels injury 2 0.0

- 0 0.0- 0 0.0- 0 0.0

Miscellaneous 1 0.0- 0 0.0

Burns (>30% BSA) 1 0.0- 0 0.0

Missing 0




Missing 0

60.1%21.5%

18.4%




PROSAFE project


National report for general ICUs - Year 2011Severity scores - Adult elective surgical patients with LOS>=24 hours evaluated in the GiViTI model

3 4 5 6 7 8 9 10 11 12 13 14 15


0

20

40

60

80

100






0−4

5−9

10−

14

15−

19

20−

24

25−

29

30−

34

35−

39

40−

44

45−

49

50−

54

55−

59

60−

64

65−

69

70−

74

75−

79

80−

84

85−

89

90−

94

95−

99

100−

104

105−

109

110−

114

115−

119

>=

120

SAPS II (%)

0

5

10

15

20

25

30

SAPSIIMean 26.1

SD 11.7Median 24Q1-Q3 18-32


0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

SOFA (%)

0

5

10

15

20

25

30

SOFAMean 3.2



PROSAFE project


National report for general ICUs - Year 2011Characteristics during the stay - Adult elective surgical patients with LOS>=24 hours evaluated in the GiViTI model


No 5407 81.5Yes 1227 18.5

Missing 0


No 6139 92.5Yes 495 7.5






A 119 1.8B 105 1.6E 68 1.0

AB 39 0.6BE 32 0.5

G 26 0.4ABE 23 0.3

AE 11 0.2D 16 0.2

ABEH 5 0.1Missing 0




Missing 0









Missing 0


None 6474 97.6Mild 41 0.6




Atelectasis 86 1.3ALI (Acute Lung Injury) 37 0.6

Pneumothorax/Pneumomediastinum 32 0.5Upper resp. tract disease 27 0.4


Acute ischaemia 47 0.7Cardiac arrest 35 0.5

Hypertensive crisis 34 0.5Pulmonary edema 36 0.5


Brain edema 17 0.3New ischaemic stroke 23 0.3

Seizures 18 0.3Post-surgical intracranial bleeding 11 0.2Gastrointestinal and hepatic 158 2.4

Intrabdominal bleeding 41 0.6Anastomotic dehiscence 25 0.4

Gastrointestinal perforation 18 0.3Bowel ischaemia 11 0.2

Gastrointestinal bleeding: lower tract 14 0.2Other 146 2.2


Metabolic disorder 36 0.5Other skin and/or soft tissue pathology 17 0.3

- 0 0.0- 0 0.0- 0 0.0


L.R.T.I. other than pneumonia 44 0.7Post-surgical peritonitis 49 0.7

NON-surgical urinary tract infection 31 0.5Post-surgical skin/soft tissue infection 26 0.4


F.U.O. fever of unknown origin 17 0.3Clinical sepsis 14 0.2

Catheter-related local infection 5 0.1Missing 0

PROSAFE project


National report for general ICUs - Year 2011Characteristics during the stay - Adult elective surgical patients with LOS>=24 hours evaluated in the GiViTI model

Infections N %



Missing 0




Missing 17




SEPTICSHOCK

TOT

Adm

issi

on

None 5985 (96.2%) 117 (1.9%) 58 (0.9%) 61 (1.0%) 6221


SEVERE SEPSIS - - 77 (90.6%) 8 (9.4%) 85

SEPTIC SHOCK - - - 73 (100.0%) 73

TOT 5985 332 149 151 6617


No 6577 99.1Yes 57 0.9

Missing 0


Estimate 7.1CI (95%) 4.7-9.9


Estimate 5.7%CI (95%) 3.8-8.0


No 6611 99.7Yes 23 0.3

Missing 0


Estimate 1.2CI (95%) 0.6-2.0


Estimate 1.4%CI (95%) 0.7-2.4

PROSAFE project


Use

On

adm

issi

onO

ndi

scha

rge

Leng

th(d

ays)

Day

sfro

mad

mis

sion

Pro

cedu

res

and/

ortre

atm

ents

(Mis

sing

=0)

N%

N%

N%

Med

ian

Q1-

Q3

Mis

sing

Med

ian

Q1-

Q3

Mis

sing

Pro

cedu

res

(ant

ibio

tics

excl

uded

)62

2393

.8In

vasi

veve

ntila

tion

4356

65.7

3668

55.3

201

31

0-1

00

0-0

0N

onin

vasi

veve

ntila

tion

595

9.0

120

1.8

126

1.9

21-

30

10-

20

Trac

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tom

y36

65.

517

42.

631

94.

85

2-12

07

4-13

0iN

O(in

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0.1

10

10

62-

100

10-

30

Cen

tralV

enou

sC

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ter

4202

63.3

3047

45.9

3636

54.8

32-

40

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Art

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5274

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2754

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22-

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Vaso

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16.7

515

7.8

132

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0A

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381

5.7

102

1.5

206

3.1

21-

40

10-

20

IAB

P3

0.0

10

00

11-

20

00-

10

Inva

sive

mon

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gof

C.O

.19

42.

969

117

0.3

32-

60

00-

20

Con

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sm

onito

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ofS

cVO

216

0.2

30

10

42-

70

00-

10

Tem

pora

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130.

28

0.1

60.

12

1-4

00

0-1

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DC

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0.7

10-

20

CP

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0.8

00-

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Mas

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139

2.1

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Intra

cran

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ure

210.

311

0.2

70.

16

2-8

00

0-1

0In

trave

ntric

ular

devi

ce38

0.6

280.

420

0.3

32-

110

20-

40

Hae

mofi

ltrat

ion

891.

32

014

0.2

42-

70

21-

50

Hae

mod

ialy

sis

831.

315

0.2

290.

43

1-6

01

1-2

0E

CM

O2

0.0

10

10

00-

10

22-

20

Hep

atic

clea

ranc

ete

chni

ques

00.

0C

lear

ance

tech

niqu

esdu

ring

seps

is11

0.2

00

20

21-

20

72-

100

IAP

(intra

-abd

omin

alpr

essu

re)

530.

8H

ypot

herm

ia14

0.2

Ent

eral

nutr

ition

939

14.2

142

2.1

630

9.5

42-

80

21-

30

Par

ente

raln

utrit

ion

1754

26.4

240

3.6

1372

20.7

31-

50

10-

20

SD

D(T

opic

al,T

opic

alan

dsy

stem

ic)

641.

0P

atie

ntre

stra

int

130

2.0

Vacu

umth

erap

y7

0.1

Ant

ibio

tics

5488

82.7

Ant

ibio

tics

fors

urgi

calp

roph

ylax

is49

9075

.239

6959

.829

3844

.32

1-3

00

0-0

0A

ntib

iotic

sfo

rmed

ical

prop

hyla

xis

160

2.4

721.

110

21.

53

2-6

00

0-1

0E

mpi

rical

antib

iotic

ther

apy

437

6.6

174

2.6

280

4.2

42-

70

10-

40

Targ

eted

antib

iotic

ther

apy

256

3.9

500.

816

62.

57

3-14

06

3-9

0

Nat

iona

lrep

ortf

orge

nera

lIC

Us

-Yea

r20

11P

roce

ssin

dica

tors

-Adu

ltel

ectiv

esu

rgic

alpa

tient

sw

ithLO

S>=

24ho

urs

eval

uate

din

the

GiV

iTIm

odel

PROSAFE project


National report for general ICUs - Year 2011Process indicators - Adult elective surgical patients with LOS>=24 hours evaluated in the GiViTI model








Missing 0





Missing 0


Mean 5.0SD 6.8

Median 2Q1-Q3 0-9




Missing 0

SDD (N=64) N %


Missing 0




Missing 18


No 6495 97.9Yes 139 2.1

Missing 0


0 6495 97.91 104 1.62 28 0.43 4 0.1

>3 3 0.0Missing 0


Mean 9.1SD 9.2

Median 6Q1-Q3 3-11

Missing 0


Gastrointestinal surgery 69 1.0Nephro/Urological surgery 17 0.3

Plastic surgery 12 0.2ENT surgery 11 0.2

Orthopaedic surgery 15 0.2Neurosurgery 16 0.2

Gynaecological surgery 5 0.1Maxillo-Facial surgery 6 0.1

Thoracic surgery 7 0.1Peripheral vascular surgery 7 0.1

Missing 0


No 6584 99.2Yes 50 0.8

Missing 0


Mean 10.0SD 10.2

Median 7Q1-Q3 3-12.2

Missing 1




Missing 0

PROSAFE project


National report for general ICUs - Year 2011Outcome indicators - Adult elective surgical patients with LOS>=24 hours evaluated in the GiViTI model

ICU outcome N %



Missing 0


Ward 5980 94.7Other ICU 111 1.8






Missing 0


Ward 5925 95.5Other ICU 79 1.3







ICU mortality N %

Alive 6386 96.3Dead 248 3.7

Missing 0




Missing 0



No 120 88.9Missing 113








Missing 3009



Missing 0


Yes 40 1.2No 3244 98.8

Missing 0


Alive 5990 90.3Dead 644 9.7

Missing 0





Mean 19.6SD 22.7

Median 12Q1-Q3 6-26

Missing 0


PROSAFE project


National report for general ICUs - Year 2011Outcome indicators - Adult elective surgical patients with LOS>=24 hours evaluated in the GiViTI model


Alive 5987 90.3Dead 645 9.7

Missing 2



Missing 0


Mean 3.3SD 5.4

Median 2Q1-Q3 1-3

Missing 0


Mean 11.2SD 16.5

Median 6Q1-Q3 3-12.2

Missing 0


Mean 14.5SD 19.8

Median 9Q1-Q3 6-16

Missing 2


SD 23.7Median 17Q1-Q3 10-28

Missing 2


Mean 22.7SD 23.3


Missing 2


Mean 28.9SD 26.4

Median 22Q1-Q3 12-36.2

Missing 0

PROSAFE project


PROSAFE project

72

National report for general ICUs - Year 2011Characteristics on admission - Adult emergency surgical patients with LOS>=24 hours evaluated in the GiViTImodel

Patients (N): 7364

Sex N %


Age (years) N %

17-45 1436 19.546-65 1680 22.866-75 1605 21.8>75 2643 35.9

Missing 0Mean 64.4

SD 19.1Median 70Q1-Q3 51-80

Min-Max 17-102




Missing 0




Missing 0

Comorbidities N %

No 1767 24.0Yes 5597 76.0

Missing 0


Hypertension 3402 46.2Arrhythmia 1041 14.1

Moderate COPD 936 12.7Cerebrovascular disease 770 10.5

Any tumour without metastasis 767 10.4Peripheral vascular disease 717 9.7

Myocardial infarction 695 9.4Diabetes Type II without insulin tr. 645 8.8

NYHA class II-III 648 8.8Moderate or severe renal disease 629 8.5

Missing 0



Missing 0



Missing 0








Missing 0










No 7355 99.9Yes 9 0.1

Missing 0

PROSAFE project

73 Emergency surgical (LOS>=24 hours)


Trauma N %

No 5553 75.4Yes 1811 24.6


Surgical status N %



0.0%0.0%

100.0%

Surgical status





Missing 0


- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0

Missing 0




Missing 0




Biliary tract surgery 298 4.0Peripheral vascular surgery 270 3.7

Splenectomy 273 3.7Nephro/Urological surgery 249 3.4

Obstetric surgery 200 2.7Other surgery 196 2.7

Missing 0




Missing 13







Missing 10


Interventional radiology 187 48.1Interventional endoscopy 70 18.0


Missing 47

PROSAFE project

Emergency surgical (LOS>=24 hours) 74











0 1 2 3 >3


0

20

40

60

80

100

24.1%27.9%

22.2%

14.1% 11.7%


No 1772 24.1Yes 5592 75.9






A 1231 16.7AB 625 8.5

ABEG 556 7.6E 473 6.4

ABE 357 4.8AC 314 4.3AE 286 3.9

B 197 2.7ABG 176 2.4AEG 160 2.2

Missing 0




Missing 0






Missing 0






None 4882 66.3Mild 1384 18.8



None 5742 78.0pH <= 7.3, PaCO2 < 45 mmHg 646 8.8


PROSAFE project





ALI (Acute Lung Injury) 139 1.9Aspiration pneumonia 115 1.6

Atelectasis 112 1.5Upper respiratory tract disease 91 1.2

Cardiovascular 895 12.2Ruptured or fissured aneurysm 250 3.4

Peripheral vascular disease 174 2.4Acute severe arrhythmia: tachycardias 125 1.7Left heart failure without pulm. edema 87 1.2

Left heart failure with pulmonary edema 59 0.8Neurological 876 11.9

Spontaneous Intraparenchymal bleeding 334 4.5Spontaneous Subarachnoid haemorrhage 211 2.9

Cerebral Aneurysm 173 2.3Cerebral artery stroke 56 0.8

Chronic Subdural haematoma 57 0.8Gastrointestinal and hepatic 3078 41.8

Gastrointestinal perforation 1005 13.6Intestinal occlusion 784 10.6

Bowel ischaemia 358 4.9Digestive tract malignancy 283 3.8

Intrabdominal bleeding (non traumatic) 251 3.4Trauma (anatomical districts) 1811 24.6

Pelvis/bone/joint & muscle 859 11.7Head 753 10.2Chest 699 9.5

Abdomen 554 7.5Spine 366 5.0

Major vessels injury 110 1.5Miscellaneous 29 0.4


Coagulation disorder 222 3.0Nephrourologic disease 197 2.7

Other disease 141 1.9Orthopaedic disease 113 1.5

Post transplantation 68 0.9Liver transplantation 37 0.5

Renal transplantation 26 0.4Infections 2175 29.5

NON-surgical secondary peritonitis 780 10.6Post-surgical peritonitis 398 5.4

Pneumonia 245 3.3Primary peritonitis 205 2.8

Cholecystitis/cholangitis 144 2.0NON-surgical skin/soft tissue infection 132 1.8

NON-surgical urinary tract infection 86 1.2L.R.T.I. other than pneumonia 52 0.7

Post-surgical skin/soft tissue infection 47 0.6Primary bacteraemia of unknown origin 28 0.4

Missing 0


Head 753 10.2Traumatic Subdural haemathoma 312 4.2

Maxillofacial fracture 253 3.4Cerebral contusion/laceration 233 3.2


Spine 366 5.0Vertebral fracture, without deficit 278 3.8

Paraplegia 30 0.4Cervical injury, incomplete deficit 22 0.3

Chest 699 9.5Traum. haemothorax/pneumothorax 322 4.4

Severe lung contusion/laceration 257 3.5Other injuries of the chest 240 3.3

Abdomen 554 7.5Spleen: Massive rupture 167 2.3


Pelvis/bone/joint & muscle 859 11.7Long bones fracture 715 9.7

Multiple fracture of the pelvis 194 2.6Very severe or open fracture of the pelvis 69 0.9

Major vessels injury 110 1.5Proximal limbs vessels: transection 48 0.7

Major abdominal vessels: transection 27 0.4Neck vessels: dissection/transection 17 0.2

Miscellaneous 29 0.4Burns (>30% BSA) 24 0.3

Inhalation injury 10 0.1- 0 0.0

Missing 0




Missing 0

37.4%

21.0%

41.7%




PROSAFE project


National report for general ICUs - Year 2011Severity scores - Adult emergency surgical patients with LOS>=24 hours evaluated in the GiViTI model

3 4 5 6 7 8 9 10 11 12 13 14 15


0

20

40

60






0−4

5−9

10−

14

15−

19

20−

24

25−

29

30−

34

35−

39

40−

44

45−

49

50−

54

55−

59

60−

64

65−

69

70−

74

75−

79

80−

84

85−

89

90−

94

95−

99

100−

104

105−

109

110−

114

115−

119

>=

120

SAPS II (%)

0

5

10

15SAPSII

Mean 40.5SD 16.6



0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

SOFA (%)

0

5

10

15

SOFAMean 5.6



PROSAFE project


National report for general ICUs - Year 2011Characteristics during the stay - Adult emergency surgical patients with LOS>=24 hours evaluated in the GiViTImodel


No 4738 64.3Yes 2626 35.7

Missing 0


No 6345 86.2Yes 1019 13.8






B 281 3.8A 164 2.2E 156 2.1

BE 63 0.9G 54 0.7

AB 43 0.6ABE 36 0.5

AE 20 0.3D 19 0.3

BH 13 0.2Missing 0




Missing 0









Missing 0


None 6998 95.0Mild 62 0.8




Atelectasis 148 2.0ALI (Acute Lung Injury) 115 1.6

ARDS 98 1.3Pneumothorax/Pneumomediastinum 57 0.8



Pulmonary edema 49 0.7Peripheral vascular disease 41 0.6


Brain edema 101 1.4Intracranial hypertension 92 1.2

Seizures 59 0.8New ischaemic stroke 45 0.6

Gastrointestinal and hepatic 433 5.9Anastomotic dehiscence 74 1.0

Bowel ischaemia 75 1.0Gastrointestinal perforation 68 0.9

Intrabdominal bleeding 53 0.7Gastrointestinal bleeding: lower tract 42 0.6



Other skin and/or soft tissue pathology 27 0.4Extremity compartment syndrome (severe) 20 0.3

Iatrogenic major vessels injury 4 0.1- 0 0.0



Catheter-related bacteremia (CR-BSI) 93 1.3Post-surgical peritonitis 86 1.2

Post-surgical skin/soft tissue infection 83 1.1Primary bacteraemia of unknown origin 59 0.8

Clinical sepsis 37 0.5Upper respiratory tract infection 39 0.5

NON-surgical secondary peritonitis 28 0.4Missing 0

PROSAFE project


National report for general ICUs - Year 2011Characteristics during the stay - Adult emergency surgical patients with LOS>=24 hours evaluated in the GiViTImodel

Infections N %



Missing 0




Missing 24




SEPTICSHOCK

TOT

Adm

issi

on

None 4491 (87.0%) 365 (7.1%) 196 (3.8%) 113 (2.2%) 5165


SEVERE SEPSIS - - 387 (84.9%) 69 (15.1%) 456

SEPTIC SHOCK - - - 906 (100.0%) 906

TOT 4491 1076 647 1126 7340


No 7050 95.7Yes 314 4.3

Missing 0


Estimate 9.2CI (95%) 7.8-10.7


Estimate 7.4%CI (95%) 6.3-8.6


No 7271 98.7Yes 93 1.3

Missing 0


Estimate 1.7CI (95%) 1.2-2.2


Estimate 2.0%CI (95%) 1.5-2.7

PROSAFE project


Use

On

adm

issi

onO

ndi

scha

rge

Leng

th(d

ays)

Day

sfro

mad

mis

sion

Pro

cedu

res

and/

ortre

atm

ents

(Mis

sing

=0)

N%

N%

N%

Med

ian

Q1-

Q3

Mis

sing

Med

ian

Q1-

Q3

Mis

sing

Pro

cedu

res

(ant

ibio

tics

excl

uded

)72

1898

Inva

sive

vent

ilatio

n63

1885

.848

9066

.483

811

.42

1-7

00

0-0

0N

onin

vasi

veve

ntila

tion

769

10.4

721

151

2.1

21-

30

21-

40

Trac

heos

tom

y10

1213

.798

1.3

832

11.3

126-

220

74-

110

iNO

(inha

led

nitr

icox

ide)

90.

10

02

05

5-10

02

0-5

0C

entra

lVen

ous

Cat

hete

r61

0682

.931

6943

4895

66.5

52-

110

00-

00

Art

eria

lCat

hete

r59

4580

.732

2843

.814

1519

.24

2-10

10

0-0

0Va

soac

tive

drug

s31

3642

.614

7120

513

72

1-5

00

0-0

0A

ntia

rrhy

thm

ics

618

8.4

142

1.9

282

3.8

32-

80

10-

20

IAB

P8

0.1

20

20

42-

40

20-

20

Inva

sive

mon

itorin

gof

C.O

.44

06.

054

0.7

540.

75

3-9

00

0-1

0C

ontin

ous

mon

itorin

gof

ScV

O2

801.

127

0.4

230.

34

2-8

00

0-0

0Te

mpo

rary

paci

ng10

0.1

30

30

42-

50

00-

40

Vent

ricul

aras

sist

ance

00.

0D

C-s

hock

630.

92

0-4

0C

PR

121

1.6

10-

70

Mas

sive

bloo

dtra

nsfu

sion

458

6.2

00-

00

Intra

cran

ialp

ress

ure

350

4.8

152

2.1

831.

18

4-14

00

0-0

0In

trave

ntric

ular

devi

ce33

94.

619

42.

616

32.

210

5-17

00

0-1

0H

aem

ofiltr

atio

n29

54.

015

0.2

530.

74

2-9

01

1-4

0H

aem

odia

lysi

s18

92.

638

0.5

831.

14

2-9

01

0-4

0E

CM

O2

0.0

10

00

84-

120

1111

-11

0H

epat

iccl

eara

nce

tech

niqu

es1

0.0

Cle

aran

cete

chni

ques

durin

gse

psis

630.

94

0.1

30

21-

40

11-

40

IAP

(intra

-abd

omin

alpr

essu

re)

226

3.1

Hyp

othe

rmia

310.

4E

nter

alnu

triti

on24

9133

.822

63.

116

3222

.27

3-15

02

1-4

0P

aren

tera

lnut

ritio

n32

3043

.942

45.

820

3627

.65

2-9

01

0-2

0S

DD

(Top

ical

,Top

ical

and

syst

emic

)15

72.

1P

atie

ntre

stra

int

265

3.6

Vacu

umth

erap

y63

0.9

Ant

ibio

tics

6551

89A

ntib

iotic

sfo

rsur

gica

lpro

phyl

axis

4087

55.5

2668

36.2

2275

30.9

31-

50

00-

00

Ant

ibio

tics

form

edic

alpr

ophy

laxi

s46

56.

313

11.

820

12.

75

2-8

00

0-0

0E

mpi

rical

antib

iotic

ther

apy

2234

30.3

1011

13.7

1351

18.3

42-

80

00-

20

Targ

eted

antib

iotic

ther

apy

1010

13.7

117

1.6

610

8.3

95-

160

63-

110

Nat

iona

lrep

ortf

orge

nera

lIC

Us

-Yea

r20

11P

roce

ssin

dica

tors

-Adu

ltem

erge

ncy

surg

ical

patie

nts

with

LOS

>=24

hour

sev

alua

ted

inth

eG

iViT

Imod

el

PROSAFE project


National report for general ICUs - Year 2011Process indicators - Adult emergency surgical patients with LOS>=24 hours evaluated in the GiViTI model








Missing 0





Missing 0


Mean 7.6SD 6.4

Median 7Q1-Q3 3-11




Missing 0

SDD (N=157) N %


Missing 0




Missing 36


No 6722 91.3Yes 642 8.7

Missing 0


0 6722 91.31 467 6.32 111 1.53 36 0.5

>3 28 0.4Missing 0


Mean 10.3SD 12.0

Median 6Q1-Q3 3-12

Missing 0



Neurosurgery 93 1.3Other surgery 55 0.7

Plastic surgery 45 0.6Maxillo-Facial surgery 38 0.5

ENT surgery 38 0.5Hepatic surgery 22 0.3

Pancreatic surgery 13 0.2Nephro/Urological surgery 17 0.2

Missing 0


No 7225 98.1Yes 139 1.9

Missing 0


Mean 12.3SD 17.6

Median 8Q1-Q3 3-16

Missing 5




Missing 0

PROSAFE project


National report for general ICUs - Year 2011Outcome indicators - Adult emergency surgical patients with LOS>=24 hours evaluated in the GiViTI model

ICU outcome N %



Missing 0


Ward 5237 85.8Other ICU 339 5.6






Missing 0


Ward 5097 89.9Other ICU 124 2.2




Ward 140 32.0Other ICU 215 49.1



ICU mortality N %

Alive 6169 83.8Dead 1195 16.2

Missing 0




Missing 0











Missing 3246



Missing 0


Yes 55 1.8No 3034 98.2

Missing 0


Alive 5431 73.8Dead 1933 26.2

Missing 0





Mean 18.9SD 23.0

Median 11Q1-Q3 5-24

Missing 0


PROSAFE project


National report for general ICUs - Year 2011Outcome indicators - Adult emergency surgical patients with LOS>=24 hours evaluated in the GiViTI model


Alive 5395 73.3Dead 1961 26.7

Missing 8



Missing 0


Mean 7.9SD 11.5

Median 4Q1-Q3 2-9

Missing 0


Mean 10.5SD 12.7

Median 6Q1-Q3 3-13

Missing 0


Mean 17.2SD 20.9

Median 11Q1-Q3 6-22

Missing 0


SD 25.8Median 19Q1-Q3 10-34

Missing 0


Mean 27.9SD 26.0


Missing 0


Mean 22.1SD 24.9

Median 14Q1-Q3 6-29

Missing 0

PROSAFE project


PROSAFE project

84

National report for general ICUs - Year 2011Characteristics on admission - Adult patients with LOS<24 hours evaluated in the GiViTI model

Patients (N): 11584

Sex N %


Age (years) N %

17-45 1433 12.446-65 2999 25.966-75 3117 26.9>75 4035 34.8

Missing 0Mean 66.7

SD 16.2Median 70Q1-Q3 58-79

Min-Max 17-102




Missing 0




Missing 0

Comorbidities N %

No 1728 14.9Yes 9856 85.1

Missing 0



Moderate COPD 1738 15.0Arrhythmia 1674 14.5

Myocardial infarction 1493 12.9Peripheral vascular disease 1330 11.5


NYHA class II-III 1250 10.8Metastatic cancer 920 7.9

Missing 0



Missing 0



Missing 0








Missing 0










No 6383 55.1Yes 5201 44.9

Missing 0

PROSAFE project

85 Adult patients (LOS<24 hours)


Trauma N %

No 10423 90.0Yes 1160 10.0


Surgical status N %



28.9%

54.0%

17.0%

Surgical status





Missing 0




Thoracic surgery 416 6.6Pancreatic surgery 336 5.4

ENT surgery 328 5.2Abdominal vascular surgery 317 5.1

Gynaecological surgery 316 5.0Peripheral vascular surgery 282 4.5

Missing 0




Missing 10



Abdominal vascular surgery 135 6.8Neurosurgery 131 6.6

Peripheral vascular surgery 112 5.7Obstetric surgery 99 5.0

Biliary tract surgery 98 5.0Nephro/Urological surgery 77 3.9

Other surgery 66 3.3Gynaecological surgery 58 2.9

Missing 0




Missing 12


None 11018 95.1Elective 181 1.6





Missing 39



Interventional radiology 76 19.7Interventional neuroradiology 35 9.1

Missing 16

PROSAFE project

Adult patients (LOS<24 hours) 86











0 1 2 3 >3


0

20

40

60

80

100

59.0%

16.8%

7.7% 5.4%11.0%


No 6840 59.0Yes 4744 41.0






E 925 8.0A 657 5.7

ABEG 536 4.6ABCEG 358 3.1

AC 211 1.8EG 186 1.6AB 173 1.5AE 148 1.3

G 139 1.2ABE 123 1.1

Missing 0




Missing 0






Missing 0






None 8652 74.7Mild 1288 11.1



None 9673 83.5pH <= 7.3, PaCO2 < 45 mmHg 731 6.3


PROSAFE project





Acute exacerbation of COPD 306 2.6Pleural effusion 203 1.8

Upper respiratory tract disease 189 1.6Pulmonary embolism 113 1.0

Cardiovascular 2344 20.2Cardiac arrest 449 3.9

Peripheral vascular disease 366 3.2Left heart failure with pulmonary edema 349 3.0

Non-ruptured aneurysm 297 2.6Acute myocardial infarction 234 2.0

Neurological 1360 11.7Brain tumour 458 4.0

Spontaneous Intraparenchymal bleeding 205 1.8Cerebral artery stroke 151 1.3


Gastrointestinal and hepatic 3020 26.1Digestive tract malignancy 1162 10.0

Intestinal occlusion 365 3.2Pancreatic malignancy 332 2.9

Gastrointestinal perforation 241 2.1Hepatic malignancy 236 2.0

Trauma (anatomical districts) 1160 10.0Pelvis/bone/joint & muscle 704 6.1

Head 316 2.7Chest 235 2.0

Abdomen 155 1.3Spine 131 1.1


Other 4029 34.8Nephrourologic disease 916 7.9

Metabolic disorder 872 7.5Orthopaedic disease 617 5.3


Post transplantation 65 0.6Renal transplantation 35 0.3

Bone marrow transplantation 7 0.1Infections 1041 9.0Pneumonia 308 2.7

NON-surgical secondary peritonitis 157 1.4Cholecystitis/cholangitis 69 0.6

Clinical sepsis 73 0.6NON-surgical skin/soft tissue infection 61 0.5


Post-surgical peritonitis 47 0.4Primary peritonitis 48 0.4

L.R.T.I. other than pneumonia 35 0.3Missing 0


Head 316 2.7Traumatic Subdural haemathoma 111 1.0

Cerebral contusion/laceration 92 0.8Traumatic subarachnoid haemorrhage 93 0.8

Maxillofacial fracture 91 0.8Skull fracture 85 0.7


Tetraplegia 6 0.1Paraplegia 7 0.1


Other injuries of the chest 98 0.8Severe lung contusion/laceration 67 0.6

Abdomen 155 1.3Liver: Moderate-Severe laceration 29 0.3

Spleen: Moderate-Severe laceration 35 0.3Spleen: Massive rupture 33 0.3



Major vessels injury 42 0.4Proximal limbs vessels: transection 19 0.2

Aorta: rupture/dissection 10 0.1Major abdominal vessels: transection 10 0.1

Miscellaneous 12 0.1Burns (>30% BSA) 11 0.1

Inhalation injury 1 0.0- 0 0.0

Missing 0




Missing 7

43.4%

14.9%

41.7%




PROSAFE project


National report for general ICUs - Year 2011Severity scores - Adult patients with LOS<24 hours evaluated in the GiViTI model

3 4 5 6 7 8 9 10 11 12 13 14 15


0

20

40

60






0−4

5−9

10−

14

15−

19

20−

24

25−

29

30−

34

35−

39

40−

44

45−

49

50−

54

55−

59

60−

64

65−

69

70−

74

75−

79

80−

84

85−

89

90−

94

95−

99

100−

104

105−

109

110−

114

115−

119

>=

120

SAPS II (%)

0

5

10

15

20

25

SAPSIIMean 32.2

SD 23.1Median 25Q1-Q3 18-37


0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

SOFA (%)

0

5

10

15

20

25

30

SOFAMean 3.8



PROSAFE project


National report for general ICUs - Year 2011Characteristics during the stay - Adult patients with LOS<24 hours evaluated in the GiViTI model


No 10209 88.1Yes 1375 11.9

Missing 0


No 11070 95.6Yes 514 4.4






B 174 1.5E 63 0.5G 53 0.5A 46 0.4

AB 20 0.2BE 25 0.2

C 20 0.2BC 6 0.1

BEH 6 0.1BG 7 0.1

Missing 0




Missing 0









Missing 0


None 11426 98.6Mild 23 0.2



Respiratory 131 1.1ARDS 29 0.3

ALI (Acute Lung Injury) 22 0.2Acute asthma/bronchospasm 7 0.1

Atelectasis 13 0.1Haemoptysis 11 0.1


Acute severe arrhythmia: tachycardias 96 0.8Acute severe arrhythmia: bradycardias 86 0.7

Pulmonary edema 64 0.6Left heart failure w/o pulm. edema 58 0.5


Brain edema 22 0.2Intracranial hypertension 26 0.2

Non-surgical intracranial bleeding 10 0.1Seizures 7 0.1

Gastrointestinal and hepatic 86 0.7Bowel ischaemia 18 0.2

Gastrointestinal bleeding: upper tract 24 0.2Intrabdominal bleeding 13 0.1

Liver Dysfunction Syndrome 7 0.1Retroperitoneal bleeding 8 0.1


Other disease 36 0.3Nephrourologic disease 26 0.2

- 0 0.0- 0 0.0

Delayed spleen rupture 1 0.0- 0 0.0

Infections 24 0.2- 0 0.0- 0 0.0

Primary bacteraemia of unknown origin 3 0.0NON-surgical bone and joint infection 1 0.0

- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0

Clinical sepsis 3 0.0Missing 0

PROSAFE project


National report for general ICUs - Year 2011Characteristics during the stay - Adult patients with LOS<24 hours evaluated in the GiViTI model

Infections N %



Missing 0




Missing 8




SEPTICSHOCK

TOT

Adm

issi

on

None 10538 (100.0%) 4 (0.0%) 0 (0.0%) 0 (0.0%) 10542


SEVERE SEPSIS - - 140 (90.9%) 14 (9.1%) 154

SEPTIC SHOCK - - - 431 (100.0%) 431

TOT 10538 435 153 450 11576

PROSAFE project


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PROSAFE project


National report for general ICUs - Year 2011Process indicators - Adult patients with LOS<24 hours evaluated in the GiViTI model

Invasive ventilation (N=6765) N %Due to pulmonary failure 1252 18.5For airway mainteinance 1553 22.9

In weaning 3393 50.1Not evaluable 575 8.5

Reintubation within 48 hours 7 0.1




Missing 0





Missing 0




Missing 0

SDD (N=38) N %


Missing 0




Missing 1

PROSAFE project


National report for general ICUs - Year 2011Outcome indicators - Adult patients with LOS<24 hours evaluated in the GiViTI model

ICU outcome N %



Missing 0


Ward 8512 90.5Other ICU 538 5.7






Missing 0


Ward 8362 93.9Other ICU 223 2.5




Ward 150 29.9Other ICU 315 62.7



ICU mortality N %

Alive 9536 82.3Dead 2048 17.7

Missing 0




Missing 0



No 891 88.7Missing 1044








Missing 5235



Missing 0


Yes 59 1.2No 5042 98.8

Missing 0


Alive 9049 78.1Dead 2535 21.9

Missing 0





Mean 17.2SD 27.7

Median 10Q1-Q3 3-21

Missing 0


PROSAFE project


National report for general ICUs - Year 2011Outcome indicators - Adult patients with LOS<24 hours evaluated in the GiViTI model


Alive 8979 77.6Dead 2592 22.4

Missing 13


Mean 11.9SD 17.0

Median 8Q1-Q3 5-14

Missing 2


SD 19.4Median 10Q1-Q3 4-18

Missing 2


Mean 16.2SD 19.3

Median 11Q1-Q3 7-19

Missing 2


Mean 8.2SD 18.3

Median 1Q1-Q3 0-9

Missing 0

PROSAFE project


PROSAFE project

96

National report for general ICUs - Year 2011Characteristics on admission - Adult elective surgical patients with LOS<24 hours evaluated in the GiViTI model

Patients (N): 6258

Sex N %


Age (years) N %

17-45 572 9.146-65 1762 28.266-75 1944 31.1>75 1980 31.6

Missing 0Mean 67.3

SD 14.4Median 70Q1-Q3 60-77

Min-Max 17-102




Missing 0




Missing 0

Comorbidities N %

No 695 11.1Yes 5563 88.9

Missing 0



Moderate COPD 1030 16.5Myocardial infarction 811 13.0

Arrhythmia 809 12.9Peripheral vascular disease 762 12.2

Diabetes Type II without insulin tr. 741 11.8Metastatic cancer 634 10.1

Cerebrovascular disease 597 9.5NYHA class II-III 572 9.1

Missing 0



Missing 0



Missing 0








Missing 0










No 1120 17.9Yes 5138 82.1

Missing 0

PROSAFE project

97 Elective surgical (LOS<24 hours)


Trauma N %

No 5856 93.6Yes 401 6.4


Surgical status N %



0.0%

100.0%

0.0%

Surgical status





Missing 0




Thoracic surgery 416 6.6Pancreatic surgery 336 5.4

ENT surgery 328 5.2Abdominal vascular surgery 317 5.1

Gynaecological surgery 316 5.0Peripheral vascular surgery 282 4.5

Missing 0




Missing 10


- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0

Missing 0




Missing 0







Missing 37




Missing 6

PROSAFE project

Elective surgical (LOS<24 hours) 98











0 1 2 3 >3


0

20

40

60

80

100

80.2%

15.6%

2.8% 0.6% 0.8%


No 5017 80.2Yes 1241 19.8






E 613 9.8A 224 3.6

EG 76 1.2G 76 1.2B 38 0.6

AB 31 0.5AE 34 0.5

ABEG 24 0.4AEG 12 0.2

BE 10 0.2Missing 0




Missing 0






Missing 0






None 5440 86.9Mild 590 9.4



None 6024 96.3pH <= 7.3, PaCO2 < 45 mmHg 101 1.6


PROSAFE project





Upper respiratory tract disease 81 1.3Pleural effusion 45 0.7

Acute exacerbation of COPD 44 0.7Acute asthma/bronchospasm 32 0.5

Cardiovascular 810 12.9Peripheral vascular disease 268 4.3

Non-ruptured aneurysm 263 4.2Systemic hypertensive crisis 42 0.7

Acute severe arrhythmia: tachycardias 43 0.7Non-congenital valvular disease 42 0.7

Neurological 566 9.0Brain tumour 420 6.7

Seizures 29 0.5Cerebral artery stroke 25 0.4

Cerebral Aneurysm 28 0.4AVM (ArterioVenous Malformation) 22 0.4Gastrointestinal and hepatic 1831 29.3

Digestive tract malignancy 1057 16.9Pancreatic malignancy 319 5.1

Hepatic malignancy 214 3.4Acute bile-duct disease 128 2.0

Intestinal occlusion 61 1.0Trauma (anatomical districts) 401 6.4

Pelvis/bone/joint & muscle 375 6.0Head 18 0.3Spine 18 0.3Chest 16 0.3

Major vessels injury 4 0.1Abdomen 2 0.0


Nephrourologic disease 778 12.4Orthopaedic disease 549 8.8


Gynaecological disease 272 4.3Post transplantation 24 0.4

Renal transplantation 15 0.2Liver transplantation 4 0.1

Infections 119 1.9Cholecystitis/cholangitis 15 0.2

Orthopaedic prosthesis infection 10 0.2Pneumonia 15 0.2


NON-surgical bone and joint infection 4 0.1Post-surgical bone and joint infection 8 0.1

Extra/retroperitoneal abscess 4 0.1Post-surgical peritonitis 4 0.1

Pleurisy/Pleural empyema 7 0.1Missing 0



Cerebral contusion/laceration 1 0.0- 0 0.0- 0 0.0- 0 0.0


- 0 0.0- 0 0.0


Other injuries of the chest 9 0.1- 0 0.0

Abdomen 2 0.0- 0 0.0

Bowel transection/perforation 1 0.0- 0 0.0



Major vessels injury 4 0.1Neck vessels: dissection/transection 1 0.0

- 0 0.0- 0 0.0

Miscellaneous 1 0.0- 0 0.0

Burns (>30% BSA) 1 0.0- 0 0.0

Missing 0




Missing 0

84.9%

6.7%8.4%




PROSAFE project


National report for general ICUs - Year 2011Severity scores - Adult elective surgical patients with LOS<24 hours evaluated in the GiViTI model

3 4 5 6 7 8 9 10 11 12 13 14 15


0

20

40

60

80

100






0−4

5−9

10−

14

15−

19

20−

24

25−

29

30−

34

35−

39

40−

44

45−

49

50−

54

55−

59

60−

64

65−

69

70−

74

75−

79

80−

84

85−

89

90−

94

95−

99

100−

104

105−

109

110−

114

115−

119

>=

120

SAPS II (%)

0

5

10

15

20

25

30

35

SAPSIIMean 21.7

SD 10.4Median 21Q1-Q3 15-27


0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

SOFA (%)

0

5

10

15

20

25

30

35

SOFAMean 2.1



PROSAFE project


National report for general ICUs - Year 2011Characteristics during the stay - Adult elective surgical patients with LOS<24 hours evaluated in the GiViTI model


No 6103 97.5Yes 155 2.5

Missing 0


No 6201 99.1Yes 57 0.9






A 21 0.3B 11 0.2

ABCE 4 0.1E 9 0.1G 6 0.1- 0 0.0

ABC 1 0.0- 0 0.0- 0 0.0- 0 0.0

Missing 0




Missing 0









Missing 0


None 6243 99.8Mild 7 0.1



Respiratory 19 0.3ALI (Acute Lung Injury) 4 0.1

Atelectasis 5 0.1Pulmonary embolism 6 0.1

- 0 0.0- 0 0.0


Acute severe arrhythmia: bradycardias 10 0.2Acute severe arrhythmia: tachycardias 10 0.2

Hypertensive crisis 5 0.1Left heart failure w/o pulm. edema 4 0.1


Brain edema 1 0.0- 0 0.0- 0 0.0- 0 0.0

Gastrointestinal and hepatic 4 0.1- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0


Other disease 13 0.2Nephrourologic disease 5 0.1

- 0 0.0- 0 0.0- 0 0.0- 0 0.0

Infections 1 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0

Missing 0

PROSAFE project


National report for general ICUs - Year 2011Characteristics during the stay - Adult elective surgical patients with LOS<24 hours evaluated in the GiViTI model

Infections N %



Missing 0




Missing 0




SEPTICSHOCK

TOT

Adm

issi

on

None 6139 (100.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 6139


SEVERE SEPSIS - - 7 (87.5%) 1 (12.5%) 8

SEPTIC SHOCK - - - 10 (100.0%) 10

TOT 6139 99 9 11 6258

PROSAFE project


Use

On

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PROSAFE project


National report for general ICUs - Year 2011Process indicators - Adult elective surgical patients with LOS<24 hours evaluated in the GiViTI model

Invasive ventilation (N=3393) N %Due to pulmonary failure 105 3.1For airway mainteinance 265 7.8

In weaning 2710 79.8Not evaluable 318 9.4

Reintubation within 48 hours 0 0.0




Missing 0





Missing 0




Missing 0

SDD (N=1) N %


Missing 0




Missing 0

PROSAFE project


National report for general ICUs - Year 2011Outcome indicators - Adult elective surgical patients with LOS<24 hours evaluated in the GiViTI model

ICU outcome N %



Missing 0








Missing 0









ICU mortality N %

Alive 6175 98.7Dead 83 1.3

Missing 0




Missing 0











Missing 2735



Missing 0


Yes 28 0.8No 3357 99.2

Missing 0


Alive 5962 95.3Dead 296 4.7

Missing 0





Mean 17.2SD 21.1

Median 11Q1-Q3 5-23

Missing 0


PROSAFE project


National report for general ICUs - Year 2011Outcome indicators - Adult elective surgical patients with LOS<24 hours evaluated in the GiViTI model


Alive 5960 95.2Dead 298 4.8

Missing 0


Mean 11.9SD 15.0

Median 8Q1-Q3 6-14

Missing 1


SD 18.7Median 13Q1-Q3 8-20

Missing 1


Mean 17.2SD 18.4

Median 12Q1-Q3 8-20

Missing 1


Mean 21.3SD 22.6

Median 15Q1-Q3 6-30.2

Missing 0

PROSAFE project


PROSAFE project

108

National report for general ICUs - Year 2011Characteristics on admission - Pediatric patients evaluated with PELOD

Patients (N): 491

Sex N %


Age N %

Newborn (0-4 weeks) 1 0.21-6 months 9 1.8

6-12 months 20 4.112-24 months 34 6.9

2-6 years 67 13.66-10 years 57 11.6

10-16 years 303 61.7Missing 0

Mean 9.8SD 5.7

Median 12Q1-Q3 4-15

Min-Max 0-16

Weight (kg)Newborns (N=1)

Mean 1.9SD

Median 1.9Q1-Q3 1.9-1.9

Missing 0

Gestational ageNewborns (N=1) N %

Pre-term (<37 weeks) 1 100.0At term (37-42) 0 0.0

Post-term (>42 weeks) 0 0.0Missing 0

Comorbidities N %

No 297 60.5Yes 194 39.5

Missing 0


Encephalopathy 41 8.4Any tumour without metastasis 35 7.1

Hemiplegia or paraplegia or quadriplegia 32 6.5Skeletal malformations/disorders 28 5.7

Asthma 17 3.5Genetic diseases 17 3.5

Hydrocephalus 15 3.1Brain and skull malformations 14 2.9

Congenital heart disease 12 2.4Endocrine-metabolic diseases 11 2.2

Missing 0

Previous ICU admissions N %

None 338 68.8<=2 42 8.6>2 29 5.9

Unknown 82 16.7Missing 0

Previous ICU admissions (N=71) N %

Paediatric 29 40.8Neonatal 22 31.0

General - adult 38 53.5Other/Unknown 4 5.6

Missing 0



Missing 0



Missing 0




High dependency care unit 3 0.6Neonatology 0 0.0

Missing 0




Missing 0


No 354 72.1Yes 137 27.9

Missing 0

PROSAFE project

109 Pediatric patients


Trauma N %

No 332 67.6Yes 159 32.4


Surgical status N %



42.8%

32.6%

24.6%

Surgical status





Missing 0


Neurosurgery 48 30.0Orthopaedic surgery 36 22.5

Maxillo-Facial surgery 20 12.5ENT surgery 18 11.2

Gastrointestinal surgery 13 8.1Nephro/Urological surgery 7 4.4

Other surgery 7 4.4Thoracic surgery 5 3.1Hepatic surgery 2 1.2

Abdominal vascular surgery 2 1.2Missing 0




Missing 0


Orthopaedic surgery 29 24.0Gastrointestinal surgery 29 24.0

Neurosurgery 27 22.3Splenectomy 19 15.7ENT surgery 8 6.6

Thoracic surgery 8 6.6Nephro/Urological surgery 7 5.8

Maxillo-Facial surgery 6 5.0Other surgery 4 3.3

Plastic surgery 3 2.5Missing 0




Missing 0





Interventional radiology 1 50.0Interventional endoscopy 1 50.0Interventional cardiology 0 0.0



Interventional radiology 3 30.0Interventional endoscopy 3 30.0


Missing 2

PROSAFE project

Pediatric patients 110











0 1 2 3 >3


0

20

40

60

80

100

49.1%

30.5%

14.5%

4.7%1.2%


No 241 49.1Yes 250 50.9






A 88 17.9AB 24 4.9AC 20 4.1

B 20 4.1AD 16 3.3

C 16 3.3D 14 2.9

ABC 10 2.0G 9 1.8

ABD 7 1.4Missing 0




Missing 0






Missing 0





PROSAFE project




Respiratory 89 18.1Upper respiratory tract disease 25 5.1

Pleural effusion 14 2.9Acute asthma/bronchospasm 11 2.2

Aspiration pneumonia 11 2.2ALI (Acute Lung Injury) 11 2.2


Acute severe arrhythmia: bradycardias 1 0.2Non-congenital valvular disease 1 0.2

Anomalous thoracic arteries or veins 1 0.2- 0 0.0

Neurological 114 23.2Seizures 49 10.0

Brain tumour 22 4.5Brain and skull malformations 14 2.9Spontaneous Hydrocephalus 8 1.6

AVM (ArterioVenous Malformation) 7 1.4Gastrointestinal and hepatic 30 6.1

Intestinal occlusion 8 1.6Gastrointestinal perforation 6 1.2

Oesophago-gastro-intestinal malf. 5 1.0Intrabdominal bleeding (non traumatic) 2 0.4

Hepatic malignancy 2 0.4Trauma (anatomical districts) 159 32.4

Head 78 15.9Abdomen 63 12.8

Pelvis/bone/joint & muscle 53 10.8Chest 52 10.6Spine 27 5.5


Other 132 26.9Other disease 32 6.5

Orthopaedic disease 30 6.1ENT/maxillofacial disease 29 5.9

Metabolic disorder 15 3.1Acute intoxication 15 3.1

Post transplantation 2 0.4Bone marrow transplantation 2 0.4

- 0 0.0Infections 73 14.9Pneumonia 34 6.9

L.R.T.I. other than pneumonia 9 1.8NON-surgical secondary peritonitis 9 1.8

Pleurisy/Pleural empyema 6 1.2Upper respiratory tract infection 6 1.2

NON-surgical CNS infection 3 0.6Primary bacteraemia of unknown origin 2 0.4

NON-surgical skin/soft tissue infection 2 0.4Post-surgical skin/soft tissue infection 2 0.4Catheter-related bacteremia (CR-BSI) 1 0.2

Missing 0



Cerebral contusion/laceration 25 5.1Skull fracture 24 4.9

Traumatic subarachnoid haemorrhage 10 2.0Extradural/epidural haematoma 9 1.8


Paraplegia 2 0.4- 0 0.0

Chest 52 10.6Severe lung contusion/laceration 27 5.5


Abdomen 63 12.8Spleen: Moderate-Severe laceration 24 4.9

Spleen: Massive rupture 17 3.5Liver: Moderate-Severe laceration 13 2.6



Major vessels injury 3 0.6Neck vessels: dissection/transection 2 0.4Proximal limbs vessels: transection 1 0.2

- 0 0.0Miscellaneous 3 0.6

Burns (>30% BSA) 2 0.4Inhalation injury 1 0.2

- 0 0.0Missing 0




Missing 1

77.8%

11.1%

11.1%




PROSAFE project


National report for general ICUs - Year 2011Severity scores - Pediatric patients evaluated with PELOD

3 4 5 6 7 8 9 10 11 12 13 14

Glasgow Coma Scale (%), Age: 0−12 months

0

20

40

60






3 4 5 6 7 8 9 10 11 12 13 14

Glasgow Coma Scale (%), Age: 1−16 years

0

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70On admissionWorst value in the first 24 hours

GCS (admission)Median 14Q1-Q3 10-14




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PELOD (%)

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PELODMean 5.0



PROSAFE project


National report for general ICUs - Year 2011Characteristics during the stay - Pediatric patients evaluated with PELOD


No 437 89.0Yes 54 11.0

Missing 0


No 481 98.0Yes 10 2.0






B 4 0.8A 3 0.6G 2 0.4

AB 1 0.2- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0

Missing 0




Missing 0









Missing 0


None 491 100.0Mild 0 0.0



Respiratory 18 3.7Atelectasis 5 1.0


ARDS 3 0.6Pneumothorax/Pneumomediastinum 3 0.6


Deep venous thrombosis 2 0.4Pulmonary edema 1 0.2

Peripheral vascular disease 1 0.2Right heart failure 1 0.2

Neurological 13 2.6Brain edema 3 0.6

Drowsiness/agitation/delirium 3 0.6Seizures 3 0.6


Gastrointestinal and hepatic 2 0.4Gastrointestinal bleeding: lower tract 1 0.2

Retroperitoneal bleeding 1 0.2- 0 0.0- 0 0.0- 0 0.0


Other skin and/or soft tissue pathology 2 0.4Fat embolism 1 0.2

Extremity compartment syndrome (severe) 1 0.2Iatrogenic major vessels injury 1 0.2


Infections 19 3.9L.R.T.I. other than pneumonia 6 1.2

Pneumonia 5 1.0NON-surgical urinary tract infection 3 0.6

Primary bacteraemia of unknown origin 2 0.4Catheter-related bacteremia (CR-BSI) 2 0.4Ventriculostomy-related CNS infection 2 0.4

Post-surgical CNS infection 1 0.2Other fungal infections 1 0.2

Post-surgical peritonitis 1 0.2Sinusitis 1 0.2

Missing 0

PROSAFE project


National report for general ICUs - Year 2011Characteristics during the stay - Pediatric patients evaluated with PELOD

Infections N %



Missing 0




Missing 1




SEPTICSHOCK

TOT

Adm

issi

on

None 405 (96.9%) 10 (2.4%) 2 (0.5%) 1 (0.2%) 418


SEVERE SEPSIS - - 8 (100.0%) 0 (0.0%) 8

SEPTIC SHOCK - - - 8 (100.0%) 8

TOT 405 65 11 9 490


No 486 99.0Yes 5 1.0

Missing 0


Estimate 5.6CI (95%) 0.9-14.5


Estimate 4.5%CI (95%) 0.8-11.6


No 489 99.6Yes 2 0.4

Missing 0


Estimate 1.6CI (95%) 0.0-5.9


Estimate 1.9%CI (95%) 0.0-7.1

PROSAFE project


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PROSAFE project


National report for general ICUs - Year 2011Process indicators - Pediatric patients evaluated with PELOD




Reintubation within 48 hours 4 1.4 5.0 3.7 4.5 3.25-6.25 0




Missing 0





Missing 0


Mean 3.5SD 6.2

Median 0Q1-Q3 0-4.5




Missing 0

SDD (N=7) N %


Missing 0




Missing 2


No 483 98.4Yes 8 1.6

Missing 0


0 483 98.41 4 0.82 1 0.23 0 0.0

>3 3 0.6Missing 0


Mean 25.3SD 21.6

Median 13Q1-Q3 10-39.2

Missing 0


Neurosurgery 8 1.6Plastic surgery 4 0.8

Orthopaedic surgery 3 0.6ENT surgery 2 0.4

Thoracic surgery 1 0.2- 0 0.0- 0 0.0- 0 0.0- 0 0.0- 0 0.0

Missing 0


No 488 99.4Yes 3 0.6

Missing 0


Mean 21.3SD 16.0


Missing 0




Missing 0

PROSAFE project


National report for general ICUs - Year 2011Outcome indicators - Pediatric patients evaluated with PELOD

ICU outcome N %



Missing 0








Missing 0









ICU mortality N %

Alive 473 96.3Dead 18 3.7

Missing 0




Missing 0



No 9 90.0Missing 8








Missing 244



Missing 0


Yes 0 0.0No 236 100.0

Missing 0


Alive 472 96.1Dead 19 3.9

Missing 0





Mean 3.0SD

Median 3Q1-Q3 3-3

Missing 0


PROSAFE project


National report for general ICUs - Year 2011Outcome indicators - Pediatric patients evaluated with PELOD


Alive 472 96.1Dead 19 3.9

Missing 0

Expected outcome (N=473) N %

Recovery/resolution of acute episode 443 93.7Palliative care grade 1 11 2.3Palliative care grade 2 1 0.2Palliative care grade 3 11 2.3Palliative care grade 4 7 1.5

Missing 0

Outcome treatments (N=30) N %

NON invasive ventilation 3 10.0Invasive ventilation 4 13.3

Oxygen therapy 4 13.3Tracheostomy 4 13.3

Diuretics grugs 1 3.3Inotropic agents drugs 0 0.0

Antiepileptics drugs 8 26.7Dialitic therapy 0 0.0

Limb replacement 0 0.0Nasogastric tube 3 10.0

Ostomies 3 10.0Home based parenteral nutrition 0 0.0

Motor physiotherapy 5 16.7Respiratory physiotherapy 4 13.3

Posture 5 16.7Psychological counselling 3 10.0

Missing 0



Missing 0


Mean 3.7SD 7.7

Median 1Q1-Q3 1-3

Missing 0


Mean 8.8SD 22.7

Median 1.5Q1-Q3 1-5.5

Missing 0


Mean 9.9SD 13.0

Median 6Q1-Q3 3-11

Missing 0


SD 19.5Median 10Q1-Q3 5-18

Missing 0


Mean 15.2SD 17.3

Median 10Q1-Q3 5-18

Missing 0


Mean 27.3SD 48.6

Median 6Q1-Q3 0-22

Missing 0

PROSAFE project


PROSAFE project

120

PROSAFE project

Appendix

121

PROSAFE project

122

National report for general ICUs - Year 2011Prognostic models - Adult patients with LOS>=to 24 hours

Model: Logistic regression.Dependent variable: Hospital mortality°.Sample used for model development: Patients with LOS>=24 hours from general Italian ICUs.Sample size: 30615 patients.

Independent variables Coefficients (95% CI) Odds Ratio (95% CI) pIntercept -14.75 (-15.42;-14.08) / /

MiscellaneaAge 0.01 (0.00;0.01) 1.01 (1.00;1.01) <0.0001Body mass Index (BMI) (Underweight vs. Normal) 0.29 (0.15;0.42) 1.33 (1.16;1.53)

<0.0001Body mass Index (BMI) (Overweight vs. Normal) -0.14 (-0.21;-0.07) 0.87 (0.81;0.94)Body mass Index (BMI) (Obese vs. Normal) -0.22 (-0.30;-0.13) 0.81 (0.74;0.88)Surgical status (Non surgical vs. Elective surgical) 0.55 (0.38;0.73) / ×

Surgical status (Emergency surgical vs. Elective surgical) 0.60 (0.46;0.73) / ×

Coming from operating theatre (Yes vs. No) -0.24 (-0.38;-0.11) 0.78 (0.69;0.89) 0.0003Admitted from other ICU for treatment continuity (Yes vs. No) -0.26 (-0.43;-0.10) 0.77 (0.65;0.90) 0.0012Stay before ICU (days) (logarithm) 0.29 (0.25;0.33) 1.34 (1.28;1.40) <0.0001Admitted in hospital the same day of ICU admission (Yes vs. No) 0.15 (0.05;0.25) 1.16 (1.05;1.28) 0.0025

ComorbiditiesSevere COPD (Yes vs. No) 0.29 (0.19;0.39) 1.34 (1.20;1.48) <0.0001Diabetes with insuline treatment (Yes vs. No) 0.23 (0.12;0.33) 1.25 (1.13;1.39) <0.0001Moderate or severe liver disease (Yes vs. No) 0.51 (0.34;0.68) 1.67 (1.40;1.98) <0.0001Autoimmune disease (Yes vs. No) 0.32 (0.16;0.49) 1.38 (1.17;1.63) 0.0002Malignant haematological disease (Yes vs. No) 0.70 (0.51;0.88) 2.01 (1.67;2.41) <0.0001Restrictive lung disease (Yes vs. No) 0.32 (0.13;0.51) 1.38 (1.14;1.66) 0.0009NYHA class II-III (Yes vs. None) 0.13 (0.04;0.22) 1.14 (1.05;1.25)

<0.0001NYHA class IV (Yes vs. None) 0.49 (0.31;0.68) 1.64 (1.36;1.96)Metastatic cancer (Yes vs. No) 0.75 (0.61;0.89) 2.11 (1.84;2.42) <0.0001

Clinical conditions on admissionARDS (Yes vs. No) 0.53 (0.35;0.70) 1.70 (1.42;2.02) <0.0001Ascites (Yes vs. No) 0.67 (0.32;1.03) 1.96 (1.37;2.80) 0.0002Systemic hypertensive crisis (Yes vs. No) -0.62 (-0.95;-0.29) 0.54 (0.39;0.75) 0.0002Seizures (Yes vs. No) -0.44 (-0.65;-0.23) 0.64 (0.52;0.79) <0.0001Spontaneous Subarachnoid haemorrhage (Yes vs. No) 0.48 (0.26;0.71) 1.62 (1.30;2.03) <0.0001Cerebral artery stroke (Yes vs. No) 0.30 (0.12;0.48) 1.35 (1.13;1.62) 0.0016Bowel ischaemia (Yes vs. No) 0.41 (0.16;0.65) 1.50 (1.18;1.91) 0.0011Acute intoxication (Yes vs. No) -1.37 (-1.78;-0.95) 0.26 (0.17;0.39) <0.0001Pulmonary hypertension (Yes vs. No) 0.52 (0.23;0.82) 1.68 (1.25;2.26) 0.0006Restrictive lung disease, exacerbation (Yes vs. No) 0.49 (0.20;0.77) 1.63 (1.23;2.16) 0.0008Left heart failure with pulmonary edema (Yes vs. No) -0.44 (-0.58;-0.30) 0.64 (0.56;0.74) <0.0001Spontaneous intracerebral bleeding (Yes vs. No) 0.53 (0.30;0.76) / ×

Traumatic diffuse brain injury with oedema (Yes vs. No) 0.94 (0.40;1.48) 2.56 (1.50;4.38) 0.0008Traumatic brain injury (Yes vs. No) -0.13 (-0.36;0.09) / ×

Multiple trauma (Yes vs. No) -0.48 (-0.69;-0.28) 0.62 (0.50;0.76) <0.0001NON-surgical urinary tract infection or Post-surgical urinary tract infection (Yes vs. No) -0.26 (-0.45;-0.06) 0.77 (0.64;0.94) 0.0084Primary peritonitis (Yes vs. None) 0.62 (0.30;0.94) 1.86 (1.35;2.57)

<0.0001NON-surgical secondary peritonitis or Tertiary peritonitis (Yes vs. None) 0.32 (0.12;0.53) 1.38 (1.13;1.70)Infection severity on admission (Infection vs. nessunaInfezione) 1.85 (0.82;2.88) / ×

Infection severity on admission (SEVERE SEPSIS vs. No infection) 2.55 (1.45;3.66) / ×

Infection severity on admission (SEPTIC SHOCK vs. No infection) 2.58 (1.45;3.71) / ×

Organ failuresPhysiopathological index∆ (logarithm) 3.27 (3.07;3.48) / ×

GCS (3,4 vs. 15) 0.07 (-0.11;0.25) / ×

GCS (Not evaluable in the first 24 hours in neurological patient* vs. 15) -0.25 (-0.59;0.09) / ×

GCS (Not evaluable in the first 24 hours in NON-neurological patient* vs. 15) 0.09 (-0.09;0.26) / ×

GCS (Worsened during first 24 hours vs. Not worsened) 0.60 (0.43;0.77) 1.82 (1.54;2.16)<0.0001GCS (Worsening not evaluable in neurological patient* vs. Not worsened) 0.32 (-0.03;0.66) 1.37 (0.97;1.93)

GCS (Worsening not evaluable in NON-neurological patient* vs. Not worsened) 0.08 (-0.14;0.30) 1.09 (0.87;1.35)Metabolic failure (Yes vs. No) 0.29 (0.21;0.37) 1.33 (1.23;1.44) <0.0001Neurologic failure (Cerebral coma vs. None) 0.17 (0.00;0.34) 1.19 (1.00;1.41)

<0.0001Neurologic failure (Metabolic coma vs. None) -0.64 (-0.88;-0.40) 0.53 (0.41;0.67)Neurologic failure (Postanoxic coma vs. None) -0.06 (-0.27;0.14) 0.94 (0.76;1.15)Neurologic failure (Toxic coma vs. None) -1.22 (-2.11;-0.34) 0.29 (0.12;0.71)Neurologic failure (Not evaluable in the first 24 hours vs. None) -0.10 (-0.26;0.06) 0.90 (0.77;1.06)Respiratory failure (Only hypoxic failure or Hypoxic-hypercapnic failure vs. None) 0.29 (0.20;0.39) 1.34 (1.22;1.47)

<0.0001Respiratory failure (Only hypercapnic failure vs. None) 0.12 (-0.02;0.27) 1.13 (0.98;1.31)Respiratory failure (Intubation for airway maint. vs. None) 0.34 (0.24;0.44) 1.40 (1.28;1.55)Cardiovascular failure (Without shock vs. None) 0.17 (0.05;0.28) 1.18 (1.05;1.33)

<0.0001Cardiovascular failure (Cardiogenic shock vs. None) 0.30 (0.18;0.42) 1.35 (1.20;1.53)Cardiovascular failure (Neurogenic shock vs. None) 0.94 (0.61;1.27) 2.56 (1.84;3.56)Cardiovascular failure (Other shock vs. None) 0.08 (-0.04;0.20) 1.08 (0.96;1.22)Cardiovascular failure (Mixed shock vs. None) 0.36 (0.12;0.60) 1.44 (1.13;1.83)(to be continued)

° For patients transferred to other ICU or to rehabilitation/high dependency care unit in other hospital, it is considered the outcome at the last hospital discharge.× See interaction significance.∆ See below.* A neurological patient is a one with an altered consciousness, probably due to a direct brain injury. It is defined by the presence of at least one of these clinical conditions on admission: Cerebral artery stroke,Vertebral basilar ischemic stroke, Intracranial hypertension, Spontaneous Hydrocephalus, Non traumatic cerebral oedema, Metabolic/postanoxic encephalopathy, Seizures, Brain tumour, Cerebral Aneurysm,AVM (ArterioVenous Malformation), Chronic Subdural haematoma, Spontaneous Subarachnoid haemorrhage, Spontaneous Intraparenchymal bleeding, CNS degenerative disease, Brain and skull malformations,Cerebral contusion/laceration, Traumatic diffuse injury without oedema, Traumatic diffuse injury with oedema, Extradural/epidural haematoma, Traumatic Subdural haemathoma, Traumatic Intraparenchimalbleeding, Traumatic subarachnoid haemorrhage, Skull fracture, NON-surgical CNS infection, Post-surgical CNS infection, Ventriculostomy-related CNS infection.

PROSAFE project

123 Models

Surgical and non surgical proceduresNephro/Urological surgery (Yes vs. No) -0.57 (-0.82;-0.32) 0.57 (0.44;0.73) <0.0001Orthopaedic surgery (Yes vs. No) -0.30 (-0.49;-0.11) 0.74 (0.61;0.89) 0.0015Biliary tract surgery (Yes vs. No) -0.31 (-0.56;-0.05) 0.74 (0.57;0.95) 0.0165Neurosurgery (Yes vs. No) 2.52 (0.51;4.54) / ×

Interventional neuroradiology (Yes vs. No) 3.77 (-0.10;7.63) / ×

Interactions among independent variablesPhysiopathological index∆ (logarithm) × Interventional neuroradiology -0.97 (-2.04;0.10) / 0.0899Physiopathological index∆ (logarithm) × Neurosurgery -0.69 (-1.24;-0.15) / 0.0159Physiopathological index∆ (logarithm) × Infections -0.50 (-0.76;-0.24) / 0.0002Surgical status (Non surgical) × Infection severity on admission (Infection) -0.18 (-0.60;0.24) /

0.0644

Surgical status (Emergency surgical)×Infection severity on admission (Infection) -0.10 (-0.55;0.35) /Surgical status (Non surgical)×Infection severity on admission (SEVERE SEPSIS) -0.67 (-1.23;-0.11) /Surgical status (Emergency surgical)×Infection severity on admission (SEVERE SEPSIS) -0.61 (-1.20;-0.02) /Surgical status (Non surgical)×Infection severity on admission (SEPTIC SHOCK ) -0.65 (-1.22;-0.08) /Surgical status (Emergency surgical)×Infection severity on admission (SEPTIC SHOCK ) -0.73 (-1.31;-0.15) /GCS (3,4) × Traumatic brain injury 0.89 (0.51;1.26) /

<0.0001GCS (Not evaluable in the first 24 hours in neurological patient*) × Traumatic brain injury 0.11 (-0.24;0.47) /GCS (Not evaluable in the first 24 hours in NON-neurological patient*) × Traumatic brain injury 0.20 (-1.00;1.39) /GCS (3,4) × Spontaneous intracerebral bleeding 0.93 (0.53;1.32) /

<0.0001GCS (Not evaluable in the first 24 hours in neurological patient*) × Spontaneous intracerebral bleeding 0.64 (0.25;1.02) /

Dependent variable explainedLikelihood Ratio Test: 9783

Degree of freedom: 81p-value: <0.0001

Goodness-of-fitArea under the ROC curve: 0.84

GiViTI Calibration Test: 1.80e-12p-value: 1

Physiopathological index

The physiopathological index is a rework of SAPSII physiopathological components. It comes from a logistic regeression model and it represents organs andsystems failure. The way it enters the model takes into account of reciprocal dependence of physiopathological components.

Independent variables Weight

Age (continuous) 0.35

GCS 3,4 22.86

GCS 5 17.27

GCS 6 12.83

GCS 7,8 9.67

GCS 9,10,11,12 5.88

GCS 13,14 4.23

GCS Not evaluable in the first 24 hours in neurological patient* 15.96

GCS Not evaluable in the first 24 hours in NON-neurological patient* 9.63

Bilirubin (mg/100ml) 4-11.9 5.47

Bilirubin (mg/100ml) >=12 9.57

Heart rate (bpm) <40 1.29

Heart rate (bpm) >=120 2.07

WBC (109/L) <1 4.11

WBC (109/L)>=20 2.45

Serum urea (mg/100 ml) >=60 4.41

Sodium (mEq/L) <125 3.92

Sodium (mEq/L) >=145 2.78

HCO3 (mEq/L) <15 2.63

Platelets (103/mm3) 99-50 3.66

Platelets (103/mm3) 49-20 8.29

Platelets (103/mm3) <20 13.37

Systolic Blood Pressure (mmHg) < 70 5.55

Systolic Blood Pressure (mmHg) 70-99 3.58

Urine Output (L/24h) <0.2 11.20

Urine Output (L/24h) 0.2-0.49 8.02

Urine Output (L/24h) 0.5-0.99 3.95

PaO2/FiO2 (100*mmHg/%) 100-199 3.36

PaO2/FiO2 (100*mmHg/%) <100 7.62

∆ See below.* A neurological patient is a one with an altered consciousness, probably due to a direct brain injury. It is defined by the presence of at least one of these clinical conditions on admission: Cerebral artery stroke,Vertebral basilar ischemic stroke, Intracranial hypertension, Spontaneous Hydrocephalus, Non traumatic cerebral oedema, Metabolic/postanoxic encephalopathy, Seizures, Brain tumour, Cerebral Aneurysm,AVM (ArterioVenous Malformation), Chronic Subdural haematoma, Spontaneous Subarachnoid haemorrhage, Spontaneous Intraparenchymal bleeding, CNS degenerative disease, Brain and skull malformations,Cerebral contusion/laceration, Traumatic diffuse injury without oedema, Traumatic diffuse injury with oedema, Extradural/epidural haematoma, Traumatic Subdural haemathoma, Traumatic Intraparenchimalbleeding, Traumatic subarachnoid haemorrhage, Skull fracture, NON-surgical CNS infection, Post-surgical CNS infection, Ventriculostomy-related CNS infection.

PROSAFE project

Models 124

National report for general ICUs - Year 2011Prognostic models - Adult patients with LOS<24 hours

Model: Logistic regression.Dependent variable: Hospital mortality°.Sample used for model development: Patients with LOS<24 hours from general Italian ICUs.Sample size: 11424 patients.

Independent variables Coefficients (95% CI) Odds Ratio (95% CI) pIntercept -7.40 (-7.93;-6.87) / /

MiscellaneaAge 0.04 (0.03;0.04) 1.04 (1.03;1.04) <0.0001Body mass Index (BMI) (Underweight vs. Normal) 0.39 (0.07;0.71) 1.47 (1.07;2.03)

<0.0001Body mass Index (BMI) (Overweight or Obese vs. Normal) -0.29 (-0.46;-0.12) 0.75 (0.63;0.89)Surgical status (Non surgical vs. Elective surgical) 0.68 (0.33;1.04) / ×

Surgical status (Emergency surgical vs. Elective surgical) 0.67 (0.41;0.93) / ×

Ward of admission (Medical ward vs. Surgical ward) 0.64 (0.32;0.97) 1.91 (1.38;2.63)

0.0006Ward of admission (Emergency room vs. Surgical ward) 0.51 (0.18;0.84) 1.67 (1.20;2.33)Ward of admission (Other ICU vs. Surgical ward) 0.66 (0.10;1.22) 1.94 (1.11;3.39)Ward of admission (High dependency care unit vs. Surgical ward) 1.07 (0.31;1.84) 2.92 (1.36;6.28)Stay before ICU (days) (logarithm) 0.44 (0.33;0.54) 1.55 (1.40;1.72) <0.0001Admitted in hospital the same day of ICU admission (Yes vs. No) 0.45 (0.17;0.74) 1.57 (1.18;2.09) 0.0019268

ComorbiditiesPeripheral vascular disease (Yes vs. No) 0.34 (0.09;0.58) 1.40 (1.10;1.79) 0.0080Any tumour without metastasis (Yes vs. None) 0.42 (0.18;0.66) 1.52 (1.20;1.94)

<0.0001Metastatic cancer (Yes vs. None) 1.07 (0.80;1.35) 2.92 (2.22;3.85)

Clinical conditions on admissionAcute intoxication (Yes vs. No) -2.20 (-3.41;-1.00) 0.11 (0.03;0.37) <0.0001Spontaneous intracerebral bleeding (Yes vs. No) 0.64 (0.19;1.09) 1.90 (1.20;2.99) 0.0062Left heart failure with pulmonary edema (Yes vs. No) -0.77 (-1.21;-0.33) 0.46 (0.30;0.72) 0.0006

Organ failuresGCS (3,4 vs. 13,14,15) 2.99 (2.58;3.40) 19.84 (13.19;29.85)

<0.0001

GCS (5 vs. 13,14,15) 1.49 (0.66;2.32) 4.43 (1.93;10.13)GCS (6 vs. 13,14,15) 1.20 (0.52;1.88) 3.32 (1.68;6.58)GCS (7,8 vs. 13,14,15) 0.83 (0.35;1.30) 2.28 (1.42;3.66)GCS (9,10,11,12 vs. 13,14,15) 0.53 (0.24;0.83) 1.71 (1.27;2.28)GCS (Not evaluable in the first 24 hours in neurological patient* vs. 13,14,15) 0.29 (-0.34;0.93) 1.34 (0.71;2.54)GCS (Not evaluable in the first 24 hours in NON-neurological patient* vs. 13,14,15) 0.37 (-0.12;0.85) 1.44 (0.89;2.34)Bilirubin (mg/100ml) (4-11.9 vs. <4) 0.75 (0.22;1.28) 2.12 (1.24;3.61)

0.0216Bilirubin (mg/100ml) (>=12 vs. <4) 0.43 (-0.72;1.59) 1.54 (0.49;4.89)Heart rate (bpm) (<40 vs. 40-120) 0.78 (0.39;1.16) 2.17 (1.48;3.19)

0.0003Heart rate (bpm) (>=120 vs. 40-120) 0.21 (-0.05;0.46) 1.23 (0.95;1.58)HCO3 (mEq/L) (<15 vs. >=15) 0.51 (0.18;0.83) 1.66 (1.20;2.30) 0.0023Platelets (103/mm3) (99-50 vs. >=100) 0.43 (0.09;0.77) 1.54 (1.10;2.16)

0.0058Platelets (103/mm3) (49-20 vs. >=100) 0.69 (0.15;1.24) 2.00 (1.16;3.44)Platelets (103/mm3) (<20 vs. >=100) 0.67 (-0.31;1.66) 1.96 (0.73;5.25)Systolic Blood Pressure (mmHg) (<70 vs. >=100) 1.34 (1.03;1.66) 3.83 (2.80;5.25)

<0.0001Systolic Blood Pressure (mmHg) (70-99 vs. >=100) 0.54 (0.34;0.74) 1.72 (1.40;2.11)Urine Output (L/24h) (<0.2 vs. >=1) 1.54 (1.23;1.86) 4.68 (3.41;6.41)

<0.0001Urine Output (L/24h) (0.2-0.49 vs. >=1) 1.41 (1.07;1.75) 4.10 (2.93;5.74)Urine Output (L/24h) (0.5-0.99 vs. >=1) 0.52 (0.30;0.74) 1.68 (1.35;2.09)PaO2/FiO2 (100*mmHg/%)(100-199 vs. >=200) 0.44 (0.20;0.68) 1.55 (1.23;1.97)

<0.0001PaO2/FiO2 (100*mmHg/%)(<100 vs. >=200) 0.94 (0.51;1.36) 2.56 (1.67;3.91)Cardiovascular failure (Without shock vs. None) 0.71 (0.27;1.15) 2.03 (1.31;3.15)

<0.0001

Cardiovascular failure (Cardiogenic shock vs. None) 1.20 (0.81;1.60) 3.34 (2.24;4.96)Cardiovascular failure (Septic shock vs. None) 1.11 (0.59;1.62) 3.03 (1.81;5.08)Cardiovascular failure (Haemorrhagic/hypovolemic shock vs. None) 1.17 (0.74;1.60) 3.21 (2.09;4.94)Cardiovascular failure (Hypovolemic shock vs. None) 0.45 (-0.23;1.13) 1.57 (0.79;3.11)Cardiovascular failure (Neurogenic shock vs. None) 2.22 (1.13;3.31) 9.18 (3.09;27.29)Cardiovascular failure (Other shock vs. None) 1.62 (0.75;2.49) 5.06 (2.12;12.09)Cardiovascular failure (Mixed shock vs. None) 1.87 (0.87;2.87) 6.49 (2.38;17.67)Respiratory failure (Only hypoxic failure vs. None) 0.49 (0.17;0.80) 1.63 (1.19;2.23)

0.0014Respiratory failure (Only hypercapnic failure vs. None) -0.04 (-0.58;0.50) 0.96 (0.56;1.65)Respiratory failure (Hypoxic-hypercapnic failure vs. None) 0.75 (0.32;1.19) 2.12 (1.37;3.28)Respiratory failure (Intubation for airway maint. vs. None) 0.31 (0.05;0.57) 1.36 (1.05;1.78)Metabolic failure (Yes vs. No) 0.50 (0.26;0.74) 1.65 (1.30;2.10) <0.0001

Surgical and non surgical proceduresGastrointestinal surgery (Yes vs. No) 0.36 (0.12;0.60) 1.43 (1.13;1.82) 0.0036Neurosurgery (Yes vs. No) 0.71 (0.32;1.10) 2.04 (1.38;3.02) 0.0006Interventional cardiology (Yes vs. No) -1.26 (-1.84;-0.67) 0.29 (0.16;0.51) <0.0001

Interactions among independent variablesSurgical status (Non surgical) × GCS Not evaluable in the first 24 hours 1.31 (0.72;1.91) /

<0.0001Surgical status (Emergency surgical) × GCS Not evaluable in the first 24 hours 0.78 (0.15;1.41) /

Dependent variable explainedLikelihood ratio test: 7586Degree of freedom: 58

p-value: <0.0001

Goodness-of-fitArea under the ROC curve: 0.95

GiViTI Calibration Test: 4.08e-13p-value: 1

° For patients transferred to other ICU or to rehabilitation/high dependency care unit in other hospital, it is considered the outcome at the last hospital discharge.× See interaction significance.* A neurological patient is a one with an altered consciousness, probably due to a direct brain injury. It is defined by the presence of at least one of these clinical conditions on admission: Cerebral artery stroke,Vertebral basilar ischemic stroke, Intracranial hypertension, Spontaneous Hydrocephalus, Non traumatic cerebral oedema, Metabolic/postanoxic encephalopathy, Seizures, Brain tumour, Cerebral Aneurysm,AVM (ArterioVenous Malformation), Chronic Subdural haematoma, Spontaneous Subarachnoid haemorrhage, Spontaneous Intraparenchymal bleeding, CNS degenerative disease, Brain and skull malformations,Cerebral contusion/laceration, Traumatic diffuse injury without oedema, Traumatic diffuse injury with oedema, Extradural/epidural haematoma, Traumatic Subdural haemathoma, Traumatic Intraparenchimalbleeding, Traumatic subarachnoid haemorrhage, Skull fracture, NON-surgical CNS infection, Post-surgical CNS infection, Ventriculostomy-related CNS infection.

PROSAFE project

125 Models

PROSAFE project

126

National report for general ICUs - Year 2011Validity of the models - Calibration belts

The calibration belt is designed to compare actually observed mortality with expected mortality according to a given

prediction model. Expected mortality is plotted on the x axis while observed mortality is plotted on the y-axis. Two

overlapping belts are presented in each graph: the first, in light grey, with a confidence level of 80%, and the second,

in dark grey, with a confidence level of 95%. The belt lying above the bisector indicates that observed mortality

is higher than expected mortality; vice versa, the belt lying below the bisector indicates that observed mortality is

lower than expected mortality. The belt is plotted in the range of expected mortality values actually present in the

sample under study. The higher the polynomial, the more complex the relationship between expected and observed

mortality. A significant Wald test (p<0.05) indicates that the belt with a confidence level of 95% does not fully include

the bisector.

These pages show the calibration belts for the SAPSII, PELOD, and GiViTI prognostic models for 2011. The latter

are reported for both the overall population and the subgroups presented in the report, according to length of stay of

more or less than 24 hours.

These belts serve as a representation of the validity of the models used to evaluate the performance of each ICU.

A model is well calibrated, and thus a useful tool for evaluating individual departments, when the bisector is fully

included in the belt. Only when this occurs can a deviation from the bisector be attributed to local factors and not to

poor calibration of the model. Poor calibration is clearly visible for SAPSII and PELOD and, accordingly, these should

be used with caution to assess the performance of individual ICUs.

For further informations please look at [PLoS ONE 6(2): e16110].

0.0 0.2 0.4 0.6 0.8 1.0

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Polynomial degree: 2Wald test, p<0.001N: 25663

Confidencelevel

Overthe bisector

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80%: NEVER 0.15−1.0095%: NEVER 0.16−1.00

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Polynomial degree: 2Wald test, p<0.001N: 491

Confidencelevel

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80%: NEVER 0.42−1.0095%: NEVER 0.56−1.00

PROSAFE project

127 Validity of the models

National report for general ICUs - Year 2011Validity of the models - Calibration belts

0.0 0.2 0.4 0.6 0.8 1.0

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Polynomial degree: 1Wald test, p=0.931N: 30995

Confidencelevel

Overthe bisector

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80%: NEVER NEVER95%: NEVER NEVER

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PROSAFE project

Validity of the models 128

Coauthors

PROSAFE project

ABBRUZZESE PASQUALE (LACCO AMENO - NA), ACCIARRI CLAUDIA (ASCOLI PICENO - AP), ACQUAROLOANNAMARIA (BRESCIA - BS), ADORNI ADELE (COMO - CO), AGOSTINELLI ROBERTO (OME - BS), AGOSTINIFULVIO (TORINO - TO), ALAMPI DANIELA (ROMA - RM), ALBERTI ARNALDO (PORTO VIRO - RO), ALBORGHETTIARMANDO (PONTE SAN PIETRO - BG), ALLEVA SANDRA (DOMODOSSOLA - VB), AMBROSONI SIMONE(LECCO - LC), ANDREONE GABRIELLA (NAPOLI - NA), ANTONINI BENVENUTO (MANERBIO - BS), ARDITIENRICO (GENOVA - GE), AVALLI LEONELLO (MONZA - MB), AZZOLINI MAURIZIO (ROVERETO - TN), BABINIMARIA (LUGO - RA), BALATA ANDREA (SASSARI - SS), BALESTRERO VIRGINIA (NOVI LIGURE - AL), BALICCOBRUNO (OSIO SOTTO - BG), BALLOTTA ANDREA (SAN DONATO MILANESE - MI), BARATTINI MASSIMO(FIRENZE - FI), BARBAGALLO MARIA (PARMA - PR), BARBERI ELISA (MASSA - MS), BASSI GIOVANNI(CARRARA - MS), BASSI GIOVANNI (MASSA - MS), BECARELLI SIMONE (PRATO - PO), BECATTINI GIOVANNA(AREZZO - AR), BECK EDUARDO (DESIO - MB), BELGIORNO NICOLANGELA (OME - BS), BELLIN MARZIA(VENEZIA - VE), BELLORINI MARIO (TRADATE - VA), BENANTI CESARE (PESCIA - PT), BENSI MARCO(TORTONA - AL), BERNASCONI MARA OLGA (ROVIGO - RO), BERRUTO FRANCESCO (PINEROLO - TO),BESOZZI ALESSANDRA (BUSTO ARSIZIO - VA), BIAMINO CRISTINA (MILANO - MI), BIANCHIN ANDREA(MONTEBELLUNA - TV), BIGNONE PAOLA (MONDOVÌ - CN), BOCCALATTE DANIELA (LUCCA - LU), BOCCHIANNA (TRECENTA - RO), BONACCORSO GIUSEPPINA (PADOVA - PD), BONAZZI MAURIZIO (CINISELLOBALSAMO - MI), BONICALZI VINCENZO (TORINO - TO), BONIOTTI CORINNA (BRESCIA - BS), BONIZZOLIMANUELA (FIRENZE - FI), BRESCHI CESARE (PESARO - PU), BRIANO GIULIO (PIETRA LIGURE - SV),BRONZINI NICOLA (BRESCIA - BS), BRUNETTI BRUNO (MILANO - MI), BRUNI ELISABETTA (CIVITANOVAMARCHE - MC), BRUNORI EMANUELA (MACERATA - MC), BRUZZONE CRISTINA (ACQUI TERME - AL),BUBBICO GIOVANNA (ROMA - RM), CALLIGARO PLINIO (BUSSOLENGO - VR), CALÒ MAURO ANTONIO(MIRANO - VE), CALVA SALLY (TORINO - TO), CANDIDO MASSIMO (FIRENZE - FI), CAPANNOLO BENITA(L’AQUILA - AQ), CAPUZZO MAURIZIA (FERRARA - FE), CARACCIOLO CRISTIANA (ABANO TERME - PD),CARACCIOLO ADALGISA (ACQUAVIVA DELLE FONTI - BA), CARAMELLI FABIO (BOLOGNA - BO), CARDISTEFANO (FIGLINE VALDARNO - FI), CARLI MANUELA (PISTOIA - PT), CARNEVALE LIVIO (PAVIA - PV),CARNEVALE LIVIO (VIGEVANO - PV), CAROLEO SANTO (CATANZARO - CZ), CASAGLI SERGIO (PISA - PI),CASAGRANDE FRANCESCA (VERONA - VR), CASALINI PIERPAOLO (FAENZA - RA), CASTIGLIONE GIACOMO(CATANIA - CT), CERADELLI MARINA (LA SPEZIA - SP), CERANA MANUELA (GENOVA - GE), CHIANI CRISTINA(ADRIA - RO), CHIARELLO MARCO (CAMERINO - MC), CIGADA MARCO (MILANO - MI), CILLONI NICOLA(BOLOGNA - BO), CIMA MAURO (TRENTO - TN), CINQUE ENRICO (LAVAGNA - GE), CIRACÒ VITO ANTONIO(JESI - AN), CLEMENTI STEFANO (SESTO SAN GIOVANNI - MI), COALOA MADDALENA (SAVIGLIANO - CN),CODELUPPI VITO (PIEVE DI CORIANO - MN), COLETTA ROSARIA (AVEZZANO - AQ), COLOMBO RINALDO(VARESE - VA), COLOMBO RICCARDO (MILANO - MI), CONVERSO MARCELLA (TORINO - TO), CORTISGRAZIANO (ROZZANO - MI), COSSETA DANIELE (MILANO - MI), COSTAGLI VALERIO (MILANO - MI), COSTANZOELEONORA (ASTI - AT), CRACCHIOLO ANDREA NEVILLE (PALERMO - PA), CREMA LUCIANO (CREMONA -CR), CRESTAN EZIO (LECCO - LC), CUSANO MARIA (BENEVENTO - BN), DA RE DOLORES (ESTE - PD), DALCERO PAOLO (CONEGLIANO - TV), DAL FERRO MARINO (ODERZO - TV), DAVID ANTONIO (MESSINA - ME),DE BLASI ROBERTO ALBERTO (ROMA - RM), DE BLASIO ELVIO (BENEVENTO - BN), DE LUCA ALESSANDRA(FIRENZE - FI), DECRISTOFARO MARIA (NAPOLI - NA), DEI POLI MARCO (SAN DONATO MILANESE - MI),DELLA MORA ERNESTO (ARZIGNANO - VI), DI MASI PIERFRANCESCO (CASTELLANA GROTTE - BA), DIPASQUALE DINO (PONTEDERA - PI), DI SERAFINO GIAMPIERO (FERMO - FM), DI STEFANO MARIA GRAZIA(CATANIA - CT), DONATO STEFANO (TERNI - TR), DONI LORENZO (FIRENZE - FI), DORONI LUCA (PISA - PI),FABI MARIA CRISTINA (FANO - PU), FACONDINI FRANCESCA (RIMINI - RN), FAGONI NAZZARENO (BRESCIA- BS), FALZETTI GABRIELE (SENIGALLIA - AN), FAVETTA PAOLA (PERUGIA - PG), FENOCCHIO GIORGIA(CESENA - FC), FERRANTE MARCO (CHIARI - BS), FIORE GILBERTO (MONCALIERI - TO), FIORENZI MARCO(MONTEPULCIANO - SI), FIUME COSIMO (NOVARA - NO), FORFORI FRANCESCO (PISA - PI), GALEONEANTONIO (PIOMBINO - LI), GALLESCHI NICOLA (EMPOLI - FI), GALLO MAURO (TORINO - TO), GAMBERINIEMILIANO (CESENA - FC), GARELLI ALBERTO (RAVENNA - RA), GENOVESI MAURIZIO (CAMAIORE - LU),GIACOMELLO STEFANO (NEGRAR - VR), GIANNI MASSIMO (AOSTA - AO), GIORDANO DONATO (LANCIANO -CH), GIOVANNI SALVI (IMPERIA - IM), GIUDICI RICCARDO (LEGNANO - MI), GIUGNI AIMONE (BOLOGNA - BO),GIUSEPPE CALICCHIO (SALERNO - SA), GORIETTI ADONELLA (PERUGIA - PG), GRASSI MODESTINA (MONZA- MB), GRASSSITELLI SERGIO (TORINO - TO), GRECO MAURIZIO (ARIANO IRPINO - AV), GUADAGNUCCIALBERTO (MASSA - MS), GUAGLIARDI CLEMENTINA (GALLARATE - VA), IANNACE ENRICO (TAORMINA -ME), ISETTA MICHELE (GENOVA - GE), LAICI CRISTIANA (BOLOGNA - BO), LANZA GIUSEPPINA (ALBA - CN),LEFONS UGO (POGGIBONSI - SI), LEGGIERI CARLO (MILANO - MI), LEMBO RITA (VERBANIA - VB), LIBRENTIMARCO (FIRENZE - FI), LIVIGNI SERGIO (TORINO - TO), LONGOBARDO ANNALISA (TORINO - TO), LUCCHELLI

129 Coauthors

PROSAFE project

MATTEO (LEGNANO - MI), MADEIRA SUSANA MONICA (BIBBIENA - AR), MADONNA ROBERTO (GROSSETO -GR), MAGATTI MARIAFEDERICA (SAN FERMO DELLA BATTAGLIA - CO), MAGGIOLO CARLO (VENEZIA - VE),MALACARNE PAOLO (PISA - PI), MANCOSU STEFANO (CAGLIARI - CA), MANNOLINI GIOVANNI (PONTREMOLI- MS), MARAFON SILVIO (VICENZA - VI), MARCEDDU ALESSANDRA (OLBIA - OT), MARCHESI GIANMARIANO(BERGAMO - BG), MARIFOGLOU DEMOSTENE (CASTEL SAN GIOVANNI - PC), MARINI GABRIELLA (CHIETI -CH), MARINO VALERIA (POZZILLI - IS), MARTINELLI PAOLO (FIRENZE - FI), MARTINELLI STEFANO (CITTÀ DICASTELLO - PG), MARTINEZ ESCOBAR RICARDO (BRESCIA - BS), MASTROIANNI ALESSANDRO (CHIERI- TO), MASTROPIERRO ROSA (BRESCIA - BS), MEDIANI TERESA SABINA (PAVIA - PV), MILAN BEATRICE(SAN BONIFACIO - VR), MODANO PASQUALINA (RIONERO IN VULTURE - PZ), MOLINO FAUSTO MARIA(ROMA - RM), MONGELLI PIERPAOLO (SIENA - SI), MORBELLI MARIO (TREVIGLIO - BG), MORIGI ARISTIDE(BOLOGNA - BO), MUTTINI STEFANO (VIMERCATE - MB), NARDI GIUSEPPE (ROMA - RM), NASCIMBENENNIO (TREVISO - TV), NATALINI GIUSEPPE (BRESCIA - BS), NAVA STEFANO (BOLOGNA - BO), NEGRIGIOVANNI (MAGENTA - MI), NEGRO GIANCARLO (CASARANO - LE), NERI MASSIMO (BOLOGNA - BO),NONINI SANDRA (MILANO - MI), ODETTO LORENZO (ORBASSANO - TO), OLIVIERI CARLO (NOVARA - NO),OSTI DARIA (FERRARA - FE), PAGANONI GUIDO (BERGAMO - BG), PALMER MAURIZIO (AVERSA - CE),PANNACCI RICCARDO (SPOLETO - PG), PAPIRI SILVANO (SAN BENEDETTO DEL TRONTO - AP), PAPOFFPAOLA (ROMA - RM), PARNIGOTTO ALESSANDRA (MONSELICE - PD), PARRINI VIERI (BORGO SAN LORENZO- FI), PASETTI GIOVANNI (ORBETELLO - GR), PASSAFIUME MARIA (PALERMO - PA), PASTORINI SIMONETTA(CAMPOSAMPIERO - PD), PEDEFERRI MATTEO (MERATE - LC), PEDULLÀ ARMANDO (BAGNO A RIPOLI - FI),PEGORARO MAURIZIO (CASTELFRANCO VENETO - TV), PELATI ERIKA (PISA - PI), PERGOLO AUGUSTO(ALESSANDRIA - AL), PERINO BERT PAOLO (CIRIÈ - TO), PERO ALICE (VERCELLI - VC), PERZOLLA DAVIDE(CHIVASSO - TO), PETA MARIO (TREVISO - TV), PEZZI ANGELO (MILANO - MI), PICAREILLO MONICA (FIRENZE- FI), PICCININI PAOLO (MODENA - MO), PIFFERI SILVIA (MILANO - MI), PINNA CRISTINA (MODENA - MO),PISU MARINA (CAGLIARI - CA), PIZZALI MARIO (MIRANO - VE), POLITO ANGELO (ROMA - RM), POOLEDANIELE (BELLUNO - BL), POSTIGLIONE MAURIZIO (NAPOLI - NA), POTALIVO ANTONELLA (BOLOGNA - BO),PRANDI EDI (MILANO - MI), PRATI PAOLO (ROMA - RM), PROSPERI MANLIO (MILANO - MI), PULICI MARCO(MILANO - MI), QUATTROCCHI PASQUALINO (CATANIA - CT), RAFFAELI MASSIMO (MILANO - MI), RANZINILUISA (MILANO - MI), RECH ALESSANDRO (VARESE - VA), RENDA BALDASSARE (PALERMO - PA), RIGHINIERMINO (LAGOSANTO - FE), RIZZI FRANCESCO (FELTRE - BL), RIZZI SABINA (PADOVA - PD), ROMAGNOLISTEFANO (FIRENZE - FI), ROSANO ANTONIO (BRESCIA - BS), ROSI ROBERTO (SIENA - SI), ROSSI SIMONA(RHO - MI), ROSSI MAURIZIO (MENAGGIO - CO), ROSSI GIANCARLO (LIVORNO - LI), ROTICIANI VALERIA(MONTEVARCHI - AR), SAGLIASCHI UGO (BORGOMANERO - NO), SALCUNI MARIA ROSA (IVREA - TO),SANGIORGI GABRIELA (BOLOGNA - BO), SCARRONE SILVIA (ALESSANDRIA - AL), SCHIAVUZZI MARINA(BRESCIA - BS), SCOLARI MARIA ANGELA (CASALMAGGIORE - CR), SEGALINI PIERAURELIO (PIACENZA -PC), SICIGNANO ALBERTO (MILANO - MI), SORBARA CARLO (TREVISO - TV), SORBELLO MASSIMO (ROMA- RM), SPAGARINO ERMANNO (BIELLA - BI), SPARICIO DONATELLA (MILANO - MI), SPECIALE ROBERTO(LECCO - LC), STORNELLI MUZIO (AVEZZANO - AQ), SUCRE MARIA JOSÉ (CASTELLAMMARE DI STABIA- NA), TANTILLO DIEGO (PALERMO - PA), TERZITTA MARINA (FORLI‘ - FC), TIBALDI GIUSEPPE (BRESCIA- BS), TODESCO LIVIO (CITTADELLA - PD), TORTA MAURO (TORINO - TO), TRIANNI LUDOVICO (PAVULLONEL FRIGNANO - MO), VAJ MONICA (TORINO - TO), VALENTINA BELLATO (ROZZANO - MI), VARDANEGAANDREA (VENEZIA - VE), VARESIO VINCENZO (SONDRIO - SO), VECCHIARELLI PIETRO (VITERBO - VT),VEDOVATI SERGIO (BERGAMO - BG), VESPIGNANI MARIA GIOVANNA (IMOLA - BO), VIOLANTE DOMENICO(OLIVETO CITRA - SA), VISCONTI MARIA GRAZIA (CERNUSCO SUL NAVIGLIO - MI), VULCANO GIUSEPPEANGELO (ROSSANO - CS), ZANNETTI PIO (NAPOLI - NA), ZANNI VITTORIO (BENTIVOGLIO - BO), ZAPPASERGIO (BRESCIA - BS), ZARDIN MICHELA (MANTOVA - MN), ZOCARO ROSAMARIA (PESCARA - PE), ZONTAGIANDOMENICO (DESENZANO DEL GARDA - BS), ZUCCARO FRANCESCO (MATERA - MT) .

Coauthors 130

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