Variability of Intensive Care Admission Decisions for the Very ElderlyReport as inadecuate

Variability of Intensive Care Admission Decisions for the Very Elderly - Download this document for free, or read online. Document in PDF available to download.

Although increasing numbers of very elderly patients are requiring intensive care, few large sample studies have investigated ICU admission of very elderly patients. Data on pre triage by physicians from other specialities is limited. This observational cohort study aims at examining inter-hospital variability of ICU admission rates and its association with patients- outcomes. All patients over 80 years possibly qualifying for ICU admission who presented to the emergency departments ED of 15 hospitals in the Paris France area during a one-year period were prospectively included in the study. Main outcome measures were ICU eligibility, as assessed by the ED and ICU physicians; in-hospital mortality; and vital and functional status 6 months after the ED visit. 2646 patients median age 86; interquartile range 83–91 were included in the study. 94% of participants completed follow-up n = 2495. 12.4% n = 329 of participants were deemed eligible for ICU admission by ED physicians and intensivists. The overall in-hospital and 6-month mortality rates were respectively 27.2% n = 717 and 50.7% n = 1264. At six months, 57.5% n = 1433 of patients had died or had a functional deterioration. Rates of patients deemed eligible for ICU admission ranged from 5.6% to 38.8% across the participating centers, and this variability persisted after adjustment for patients- characteristics. Despite this variability, we found no association between level of ICU eligibility and either in-hospital death or six-month death or functional deterioration. In France, the likelihood that a very elderly person will be admitted to an ICU varies widely from one hospital to another. Influence of intensive care admission on patients- outcome remains unclear.

Trial Registration NCT00912600

Author: Ariane Boumendil , Derek C. Angus, Anne-Laure Guitonneau, Anne-Marie Menn, Christine Ginsburg, Khalil Takun, Alain Davido, Rafik



Related documents