A new study from Karolinska Institutet, published in BMJ Global Health, shows that one in eight patients admitted to hospitals are critically ill, and most of these patients are cared for outside intensive care units. The researchers behind the study believe that simple but underutilised care could save many lives at a low cost.
The same research group recently published a study in The Lancet showing a high prevalence of critical illness in African hospitals . Now, they have shown a similar prevalence of critical illness in eight hospitals across three countries with different economic conditions: Sweden, Sri Lanka, and Malawi.
High prevalence and mortality
A total of 439 out of 3652 hospitalised patients, 12 percent, were critically ill. A full 96 percent of these were cared for in regular wards, not in intensive care units, and nearly 19 percent of the patients died.
In Sweden, the prevalence of critical illness was 10.5 percent. Of the critically ill patients, 94 percent were cared for in regular wards, and nearly 18 percent died during their hospital stay.
"Our results show that critical illness is much more common than policymakers and the public believe, with high prevalence and mortality globally - and also in Sweden. To save many lives, we need to focus on improving the care of critically ill patients in regular wards where the vast majority of the critically ill receive their care," says Carl Otto Schell , doctor and researcher at the Department of Global Public Health, Karolinska Institutet.
Simple life-saving care
The study emphasises the need to implement cost-effective and feasible care measures outside intensive care units. Researchers at Karolinska Institutet have previously, in a large international collaboration, developed a concept for essential care of critical illness, called EECC (Essential Emergency and Critical Care).
"This simple life-saving care is both cheap and effective but often missed. A clearer focus on EECC could save many lives at a low cost," says Tim Baker , doctor and associate professor at the same department at Karolinska Institutet.
See the scientific article for information on funding and potential conflicts of interest.
Publication
" Hospital burden of critical illness across global settings: a point prevalence and cohort study in Malawi, Sri Lanka and Sweden ", Carl Otto Schell, Raphael Kazidule Kayambankadzanja, Abi Beane, Andreas Wellhagen, Chamira Kodippily, Anna Hvarfner, Grace Banda, Nalayini Jegathesan, Christoffer Hintze, Wageesha Wijesiriwardana, Martin Gerdin Wärnberg, Jayasingha Arachchilage Sujeewa, Mtisunge Kachingwe, Petronella Bjurling-Sjöberg, Isaac Mbingwani, Annie Kalibwe Mkandawire, Hampus Sjöstedt, Wezzie Kumwenda-Mwafulirwa, Surenthirakumaran Rajendra, Odala Kamandani Dzinjalamala, Cecilia Stalsby Lundborg, Kwazizira Samson Mndolo, Miklós Lipcsey, Rashan Haniffa, Lisa Kurland, Markus Castegren, Tim Baker, BMJ Global Health, online 25 March 2025, doi: https://doi.org/10.1136/bmjgh-2024-017119
