Delayed Admission to the Intensive Care Unit Is Associated With Increased Mortality Risk in Critically Ill Patients: A Prospective Cohort Study.

Single-centre design at one regional hospital, so results may not apply where ICU capacity, staffing or transfer processes differ. Delay was defined as more than 5 hours using an Australian policy plus a 1-hour operational buffer, and different thresholds may change the findings. SOFA scores were measured only after ICU admission, so the study cannot tell whether higher scores in delayed patients reflected deterioration during the delay or baseline illness severity. Observational design means residual confounding is possible; diagnosis type and illness severity at ED presentation were not fully adjusted for. The study was powered to detect moderate SOFA differences, and the paper states that about 538 patients would be needed to detect a small effect, so null SOFA comparisons may reflect limited power. Follow-up was limited to the hospital stay, and total follow-up time was not collected. Long-term morbidity or quality of life after discharge were not measured. Types and causes of ICU admission delay were not distinguished. Reliance on one hospital's routine and paper data could introduce site-specific measurement or recording differences.

Funding was from Queensland Health's Clinical Research Fellowship Novice Researcher grant (Rural, Regional and Remote category-2024).

Do not read the 7.5% and 6.8% odds increases as the effect of ICU admission delay itself. Those figures are for each one-point increase in highest SOFA score and each one-unit increase in 24-hour SOFA score, and the SOFA score differences between delayed and non-delayed groups were not statistically significant.