Biomedical subjects
Reidar Kvåle
Publications and source records attributed to Reidar Kvåle.
Follow-up after intensive care: a single center study.
OBJECTIVES: To study health problems, quality of life, functional status, and memory after intensive care. SETTING: Adult patients ( n=346) discharged from a university hospital ICU. DESIGN AND METHODS: Prospective cohort study. Follow-up patients were found using the ICU database and the Peoples Registry. Quality of life (QOL) was measured with the Short Form 36 (SF-36) 6 months after ICU discharge. Semi-structured interviews, questionnaires, Glasgow Outcome Score (recovery), and Karnofsky Index (functional status) were used at consultations 7-8 months after ICU discharge. RESULTS: The SF-36 response rate was 64.5%, with scores significantly lower than population scores. Consultation patients ( n=136) did not differ from the rest ( n=210) regarding age, SAPS II scores, length of stay (LOS), and reasons for ICU admission. At follow-up 67.6% of consultation patients continued most activities, 75% looked after themselves, and 64.7% were non-workers, compared to 40.4% before the ICU admission. During and after the ICU stay, 40% lost more than 10 kg body weight. Fifty-eight (43%) could not remember anything from their ICU stay. At follow-up only 22 (16%) could remember having received information during their ICU stay. Three patients needed referral to other specialties. CONCLUSIONS: We should focus more on optimizing symptom management and giving repeated information after ICU discharge. Nutritional status and weight loss is another area of concern. More research is needed to find out how the broad range of psychosocial and physical problems following an ICU stay relates to the stay.
Cost of intensive care in a Norwegian University hospital 1997-1999.
AIM: The present study was performed in order to document costs of intensive care in a Norwegian university hospital and to perform an average cost-effectiveness study using the expected remaining life-years in survivors after 18 months. MATERIALS AND METHODS: Patients admitted to the general intensive care unit (ICU) at Haukeland University Hospital from 1997 to 1999 were followed up to 18 months post ICU using data from the Norwegian Peoples' registry. Our ICU patients have a further mortality equal to the average population in Norway from that time. By creating an age-matched and sex-matched sample of the general Norwegian population equal to survivors 18 months after ICU treatment, we could find the expected further survival time for each ICU survivor. Direct and indirect ICU expenses in the study period were retrieved using a 'top-down' method. Outcome assessment was performed using the total ICU expenses in the period divided by the sum of the life expectancy (years) in survivors after 18 months. RESULTS: The total ICU costs (converted to 2001 values) were 16,697,415, excluding the costs of radiology and the use of operating theatres, which were both impossible to retrieve. A total of 1051 patients were treated, of whom 60.9% survived up to 18 months. Further total life expectancies were 24,428 years. The average costs of an ICU day and stay per patient were 2601 and 14,223, respectively, and the average cost per year of survival per patient was 684. DISCUSSION: The absolute costs were found to be higher than recent European ICU studies reporting on the cost of ICU treatment. However, the price of a further life-year in survivors was lower and was comparable with other medical treatment.
Changes in intensive care from 1987 to 1997 - has outcome improved? A single centre study.
OBJECTIVES: To study changes in a single intensive care unit (ICU) over a 10 year period and to investigate possible concomitant changes in outcome. SETTING: The ICU populations in 1987 and 1997 in a university hospital. DESIGN AND METHODS: Prospective and retrospective cohort study. The ICU database was used for comparison of the ICU populations, and SAPS II-estimated hospital survival was compared with observed survival. Three year follow-up survival (the Peoples Registry) was compared with population survival (Statistics Norway). In the year 2000 the Short Form 36 (SF 36) questionnaire was used for quality of life (QOL) measurement. Results were compared with a reference population. INTERVENTIONS: None. RESULTS: From 1987 to 1997 the numbers of patients and stays increased from 219 and 236 to 338 and 370. ICU activity per stay increased considerably, but length of stay remained unchanged (6.0 versus 5.9 days). The 1997 ICU patients were, on average, older (50.3 versus 46.0 years) and more severely ill (SAPS II 42.7 versus 34.7). They had a higher crude mortality, but the time from admission to when the observed mortality reached the predicted mortality was longer, indicating an increased survival length. Two years after intensive care, there was no excess mortality compared with population survival in either cohort. QOL was significantly reduced in both cohorts compared to population scores. CONCLUSIONS: This study indicates that the increased intensive care activity over the 10 year period was associated with a prolonged severity-adjusted survival. QOL was still reduced 3 and 13 years after ICU, compared to population scores.