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Variability of intensive care admission decisions for the very elderly

Boumendil, A and Angus, DC and Guitonneau, AL and Menn, AM and Ginsburg, C and Takun, K and Davido, A and Masmoudi, R and Doumenc, B and Pateron, D and Garrouste-Orgeas, M and Somme, D and Simon, T and Aegerter, P and Guidet, B (2012) Variability of intensive care admission decisions for the very elderly. PLoS ONE, 7 (4).

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Abstract

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: ClinicalTrials.gov NCT00912600. © 2012 Boumendil et al.

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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Boumendil, A
Angus, DCangusdc@pitt.eduANGUSDC0000-0002-7026-5181
Guitonneau, AL
Menn, AM
Ginsburg, C
Takun, K
Davido, A
Masmoudi, R
Doumenc, B
Pateron, D
Garrouste-Orgeas, M
Somme, D
Simon, T
Aegerter, P
Guidet, B
Contributors:
ContributionContributors NameEmailPitt UsernameORCID
InvestigatorSimon, TUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorSomme, DUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorPateron, DUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorGarrouste-Orgeas, MUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorBoumendil, AUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorAegerter, PUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorGuidet, BUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorElkharrat, DUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorBenhamou, FUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorJardin, FUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorHoang-the-dan, PUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorHamza, LUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorCohen, YUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorCasalino, EUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorDoumenc, BUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorRichard, CUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorFichelle, AUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorGuitonneau, A LUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorRegnier, BUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorGinsburg, CUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorTakun, KUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorMira, J PUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorDavido, AUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorMasmoudi, RUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorFagon, J YUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorPateron, DUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorBenkel, JUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorDhonneur, GUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorPayen de la Garanderie, DUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorPlaisance, PUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorBaud, FUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorRoupie, EUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorNgako, AUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorBrun-Buisson, CUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorPhlippoteau-Parin, CUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorPallot, J LUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorRiou, BUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorRay, PUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorChastre, JUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorHéricord, PUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorReinhart, IUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorOffenstadt, GUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorCordier, BUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorHoffman, FUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorCarlet, JUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorMeyniel, DUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorBouvard, PUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorMayaud, CUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorBleichner, BUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorMenn, A MUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
InvestigatorMentec, HUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
EditorGupta, VineetUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Date: 18 April 2012
Date Type: Publication
Journal or Publication Title: PLoS ONE
Volume: 7
Number: 4
DOI or Unique Handle: 10.1371/journal.pone.0034387
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
MeSH Headings: Aged, 80 and over; Decision Making; Emergency Medical Services--statistics & numerical data; Female; Humans; Intensive Care Units--statistics & numerical data; Male; Patient Admission--statistics & numerical data; Triage--statistics & numerical data
PubMed Central ID: PMC3324496
PubMed ID: 22509296
Date Deposited: 24 Sep 2012 20:26
Last Modified: 19 Dec 2019 14:55
URI: http://d-scholarship.pitt.edu/id/eprint/14171

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