Admission patterns and outcomes of patients admitted to critical care in the UK with surgically treated facial infection: an analysis of the Intensive Care National Audit and Research Centre Case Mix Programme database


      Facial infections are common and can occasionally be severe. A small number of patients may develop severe sepsis or airway compromise requiring critical care admission. We examined a national intensive care database to assess patterns of admission and outcomes for patients in this cohort. An analysis was performed of the Intensive Care National Audit and Research Centre (ICNARC) Case Mix Programme database. Data were extracted on case mix and outcomes for patients coded as ‘mandible, facial bones, dental, and salivary infection’ admitted to critical care between 2010 and 2019. Data included admission numbers, demographics, comorbidities, physiology scores, and outcomes including length of stay and mortality. There were 2820 admissions for patients with facial infections from 212 CCUs over the ten-year period. Admissions increased from 194 in 2010 to 368 in 2019. These admissions accounted for 0.16% of overall admissions in 2010 and 0.21% in 2019, a statistically significant increase in the rate of admissions, p < 0.001. The median age of patients was 48 years and 62.7% were male. Sepsis was present in 77.6% of patients. The median length of stay in critical care was 49 hours (IQR 23.2, 100.3 hours). The median total hospital stay was 7 days (IQR 4, 16 days). The rate of admissions to CCUs for facial infection remains low overall but has significantly increased over the last decade. With increasing demand for this resource ongoing monitoring of utilisation is important.


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        • Brennan P.
        • Schliephake H.
        • Ghali G.E.
        • et al.
        Maxillofacial Surgery.
        3rd ed. Elsevier, 2016
        • Pappa H.
        • Jones D.C.
        Mediastinitis from odontogenic infection. A case report.
        Br Dent J. 2005; 198: 547-548
        • Tapiovaara L.
        • Bäck L.
        • Aro K.
        Comparison of intubation and tracheotomy in patients with deep neck infection.
        Eur Arch Otorhinolaryngol. 2017; 274: 3767-3772
        • Harrison D.A.
        • Brady A.R.
        • Rowan K.
        Case mix, outcome and length of stay for admissions to adult, general critical care units in England, Wales and Northern Ireland: the intensive care national audit & research centre case mix programme database.
        Crit Care. 2004; 8: R99-R111
        • Singer M.
        • Deutschman C.S.
        • Seymour C.W.
        • et al.
        The third international consensus definitions for sepsis and septic shock (Sepsis-3).
        JAMA. 2016; 315: 801-810
        • Ferrando-Vivas P.
        • Jones A.
        • Rowan K.M.
        • et al.
        Development and validation of the new ICNARC model for prediction of acute hospital mortality in adult critical care.
        J Crit Care. 2017; 38: 335-339
        • Khatri I.A.
        • Wasay M.
        Septic cerebral venous sinus thrombosis.
        J Neurol Sci. 2016; 362: 221-227
        • Garantziotis S.
        • Kyrmizakis D.E.
        • Liolios A.D.
        Critical care of the head and neck patient.
        Crit Care Clin. 2003; 19: 73-90
        • Abu Al-Saad N.
        • Skedgel C.
        • Nortje J.
        Principles of resource allocation in critical care.
        BJA Education. 2017; 17: 390-395
        • Richards-Belle A.
        • Orzechowska I.
        • Gould D.W.
        • et al.
        COVID-19 in critical care: epidemiology of the first epidemic wave across England, Wales and Northern Ireland.
        Intensive Care Med. 2020; 46: 2035-2047
        • Harrison D.A.
        • D’Amico G.
        • Singer M.
        Case mix, outcome, and activity for admissions to UK critical care units with severe acute pancreatitis: a secondary analysis of the ICNARC case mix programme database.
        Crit Care. 2007; 11: S1
        • Damian M.S.
        • Ben-Shlomo Y.
        • Howard R.
        • et al.
        Admission patterns and survival from status epilepticus in critical care in the UK: an analysis of the intensive care national audit and research centre case mix programme database.
        Eur J Neurol. 2020; 27: 557-564
        • McPhail M.J.
        • Parrott F.
        • Wendon J.A.
        • et al.
        Incidence and outcomes for patients with cirrhosis admitted to United Kingdom critical care units.
        Crit Care Med. 2018; 46: 705-712
        • Park D.P.
        • Welch C.A.
        • Harrison D.A.
        • et al.
        Outcomes following oesophagectomy in patients with oesophageal cancer: a secondary analysis of the ICNARC case mix programme database.
        Crit Care. 2009; 13: S1
        • Fu B.
        • McGowan K.
        • Sun H.
        • et al.
        Increasing use of intensive care unit for odontogenic infection over one decade: incidence and predictors.
        J Oral Maxillofac Surg. 2018; 76: 2340-2347
        • Ylijoki S.
        • Suuronen R.
        • Jousimies-Somer H.
        • et al.
        Differences between patients with or without the need for intensive care due to severe odontogenic infections.
        J Oral Maxillofac Surg. 2001; 59: 867-872
        • Riekert M.
        • Kreppel M.
        • Zöller J.E.
        • et al.
        Severe odontogenic deep neck space infections: risk factors for difficult airways and ICU admissions.
        Oral Maxillofac Surg. 2019; 23: 331-336
        • Sarna T.
        • Sengupta T.
        • Miloro M.
        • et al.
        Cervical necrotizing fasciitis with descending mediastinitis: literature review and case report.
        J Oral Maxillofac Surg. 2012; 70: 1342-1350
        • Misthos P.
        • Katsaragakis S.
        • Kakaris S.
        • et al.
        Descending necrotizing anterior mediastinitis: analysis of survival and surgical treatment modalities.
        J Oral Maxillofac Surg. 2007; 65: 635-639
        • Ali S.
        Cavernous sinus thrombosis: efficiently recognising and treating a life threatening condition.
        Cureus. 2021; 13e17339
        • Zhang F.
        • Hsu G.
        • Das S.
        • et al.
        Independent risk factors associated with higher mortality rates and recurrence of brain abscesses from head and neck sources.
        Oral Surg Oral Med Oral Pathol Oral Radiol. 2021; 131: 173-179
        • Carter L.M.
        • Layton S.
        Cervicofacial infection of dental origin presenting to maxillofacial surgery units in the United Kingdom: a national audit.
        Br Dent J. 2009; 206: 73-78
        • Bowe C.M.
        • Gargan M.L.
        • Kearns G.J.
        • et al.
        Does access to general dental treatment affect the number and complexity of patients presenting to the acute hospital service with severe dentofacial infections?.
        J Ir Dent Assoc. 2015; 61: 196-200
        • Saloman D.
        • Heidel R.E.
        • Kolokythas A.
        • et al.
        Does restriction of public health care dental benefits affect the volume, severity, or cost of dental-related hospital visits?.
        J Oral Maxillofac Surg. 2017; 75: 467-474
        • Dawoud B.E.
        • Kent S.
        • Ho M.W.
        Impacts of lockdown during the SARS-CoV-2 pandemic on patients presenting with cervicofacial infection of odontogenic origin: a comparative study.
        Br J Oral Maxillofac Surg. 2021; 59: e109-e113
        • Parara E.
        • Krasadakis C.
        • Toursounidis I.
        • et al.
        Significant rise in neck infections progressing to descending necrotizing mediastinitis during the COVID-19 pandemic quarantine.
        J Craniomaxillofac Surg. 2021; 49: 1182-1186