The following is a summary of “Impact Of Patient Admission Source On Respiratory Intensive Care Unit Outcomes,” published in the March 2025 issue of the BMC Pulmonary Medicine by Durak et al.

Understanding the impact of admission sources on mortality rates in patients who were critically ill is essential for optimizing intensive care unit (ICU) triage and resource allocation. However, limited research has explored the correlation between ICU admission origin—either from the emergency department (ED) or hospital ward—and patient outcomes. This study aims to investigate the association between ICU admission source and mortality rates in patients with acute respiratory failure, highlighting key factors influencing prognosis.

A retrospective observational cross-sectional study was conducted in the ICU of a tertiary pulmonology teaching hospital between January 1, 2018, and December 31, 2019. The study included 2,173 patients admitted for acute respiratory failure, with 1,011 (46%) admitted from the ED and 1,162 (54%) from the ward. Data collected included demographic characteristics, comorbidities, primary diagnoses, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, mechanical ventilation requirements (invasive or noninvasive), ICU length of stay, and mortality outcomes. Statistical analyses were performed to compare mortality rates between the two admission groups and identify factors associated with increased mortality risk.

The mean age of the study population was 70 years, and 66% were male. Pneumonia was the most frequent cause of ICU admission (60%), while chronic obstructive pulmonary disease (COPD) was the most common underlying comorbidity (54%). Analysis of respiratory support utilization revealed that noninvasive mechanical ventilation (NIV) was more frequently administered in patients admitted from the ED (50% vs. 35%, ED vs. ward), whereas invasive mechanical ventilation was required more often in ward-admitted patients (25% vs. 17%, ward vs. ED). The median ICU length of stay was significantly longer for ward-admitted patients compared to patients who were ED-admitted (3 vs. 2 days, P < 0.001). Mortality rates were also higher among patients transferred from the ward, with an odds ratio of 1.66 (95% CI: 1.297–2.124, P < 0.001). Further analysis identified pneumonia, malignancies, interstitial lung disease, and NIV failure as factors contributing to increased mortality risk.

These findings suggest that patients admitted to the ICU from the ward exhibit a higher mortality risk than those admitted directly from the ED. This disparity may be attributed to delays in recognizing critical illness in ward patients, resulting in more severe clinical deterioration at the time of ICU transfer. Enhanced triage protocols and early intervention strategies in the ED could improve patient outcomes by facilitating timely ICU admissions and preventing delays in critical care. Future research should explore strategies to optimize admission decisions and assess the impact of early critical care interventions on survival outcomes in patients with acute respiratory failure.

Source: bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-025-03583-3