Aged, 80 and over; Analysis of Variance; Critical Illness/mortality/therapy; Decision Making; Female; France/epidemiology; Hospital Mortality; Humans; Intensive Care Units; Male; Outcome Assessment (Health Care); Prospective Studies; Quality of Life; Referral and Consultation; Refusal to Treat; Statistics, Nonparametric; Triage
Abstract :
[en] OBJECTIVE: To describe triage decisions and subsequent outcomes in octogenarians referred to an ICU. DESIGN AND SETTING: Prospective observational study in the medical ICU in a tertiary nonuniversity hospital. PARTICIPANTS: Cohort of 180 patients aged 80 years or over who were triaged for admission. MEASUREMENTS: Age, underlying diseases, admission diagnoses, Mortality Probability Model score, and mortality were recorded. Self-sufficiency (Katz Index of Activities of Daily Living) and quality of life (modified Perceived Quality of Life scale and Nottingham Health Profile) were measured 1year after triage. RESULTS: In 132 patients (73.3%) ICU admission was refused, including 79 (43.8%) considered too sick to benefit. Factors independently associated with refusal were nonsurgical status, age older than 85 years, and full unit. Greater self-sufficiency was associated with ICU admission. Hospital mortality was 30/48 (62.5%), 56/79 (70.8%), 9/51 (17.6%), and 0/2 in the admitted, too sick to benefit, too well to benefit, and family/patient refusal groups, respectively; 1-year mortality was 34/48 (70.8%), 69/79 (87.3%), 24/51 (47%), and 0/2, respectively. Self-sufficiency was unchanged by ICU stay. Quality of life (known in only 28 patients) was significantly poorer for isolation, emotional, and mobility domains compared to the French general population matched on sex and age. CONCLUSIONS: More than two-thirds of patients aged over 80 years referred to our ICU were denied admission. One year later self-sufficiency was not modified and quality of life was poorer than in the general population. These results indicate a need to discuss patient preferences before triage decisions.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Garrouste-Orgeas, Maite
Timsit, Jean-Francois
Montuclard, Luc
Colvez, Alain
Gattolliat, Olivier
Philippart, Francois
Rigal, Guillaume
Misset, Benoît ; Centre Hospitalier Universitaire de Liège - CHU > Autres Services Médicaux > Service des soins intensifs
Carlet, Jean
Language :
English
Title :
Decision-making process, outcome, and 1-year quality of life of octogenarians referred for intensive care unit admission.
Somogyi-Zalud E, Zhong Z, Hamel MB, Lynn J (2002) The use of life-sustaining treatments in hospitalized persons aged 80 and older. J Am Geriatr Soc 50:930-934
Tsevat J, Dawson NV, Wu AW, Lynn J, Soukup JR, Cook F, Vidaillet H, Phillips RS for the HELP investigators (1998) Health values of hospitalized patients 80 years or older. JAMA 279:371-375
Nilsson M, Eckman S, Ericsson K, Winblad B (1996) Some characteristics of the quality of life in old age illustrated by mean's of Allardt's concept. Scand J Caring Sci 116-121
Somme D, Maillet JM, Gisselbrecht M, Novara A, Ract C, Fagon JY (2003) Critically ill old and the oldest-old patients in intensive care: short and long term outcomes. Intensive Care Med 29:2137-2143
Boumendil A, Maury E, Reinhard I, Luquet L, Offenstadt G, Guidet B (2004) Prognosis of patients aged 80 years and over admitted in medical intensive care unit. Intensive Care Med 30:647-654
Azoulay E, Pochard F, Chevret S, Vinsonneau C, Garrouste-Orgeas M, Cohen Y, Thuong M, Paugam C, Appere C, De Cagny B, Brun F, Borstein C, Parrot A, Tamion F, Lacherade JC, Bouffard Y, Le Gall JR, Herve C, Grassin M, Zittoun R, Schlemmer B, Dhainaut JF (2001) Compliance with triage to intensive care recommendations. Crit Care Med 29:2132-2139
Sprung CL, Geber D, Eidelman LA, Baras M, Pizov R, Nimrod A (1999) Evaluation of triage decisions for intensive care admission. Crit Care Med 27:1073-1079
Joynt GM, Gomersall CD, Tan P, Lee A, Ai YU Chen C, Lai Yi Wong E (2001) Prospective evaluation of patients refused admission to intensive care unit: triage, futility and outcome. Intensive Care Med 27:1459-1465
Chelluri L, Pinski MR, Grenvik A (1992) Outcome of intensive care of the oldest-old critically ill patients. Crit Care Med 20:757-761
Covinski KE, Wu AW, Landefeld S, Connors AF, Phillips RS, Tsevat J, Dawson NV, Lynn J, Fortinsky RH (1999) Health status versus quality of life in older patients: does the distinction matter? Am J Med 106:435-440
Kass JE, Castriotta BJ, Malakoff F (1992) Intensive care unit outcome in the very elderly. Crit Care Med 20:1666-1671
Garrouste-Orgeas M, Timsit JF, Montuclard L, Gattolliat O, Philippart F, Rigal G, Misset B, Carlet J (2004) Preliminary study of ICU admission procedures in patients over 80 years and one-year outcome, functional capacity and quality of life. Intensive Care Med 30:S101
Garrouste-Orgeas M, Montuclard L, Timsit JF, Misset B, Christias M, Carlet J (2003) Triaging patients to the ICU: a pilot study of factors influencing admission decision and outcome. Intensive Care Med 29:774-781
Garrouste-Orgeas M, Montuclard L, Reignier J, Desmettre T, Karoubi P, Moreau D, Montesino L, Duguet A, Boussat S, Ede C, Monseau Y, Paule T, Misset B, Carlet J (2005) Predictors of ICU refusal in French ICUs. Crit Care Med 33:750-755
McCabe WR, Jackson GG (1962) Gram negative bacteremia: etiology and ecology. Arch Intern Med 110:847-855
Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE (1981) APACHE acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med 9:591-597
Lemeshow S, Teres D, Klar J, Avrunin JS, Gehlbach SH, Rapoport J (1993) Mortality Probability Models (MPM II) based on an inteipretation cohort of intensive care unit patients. JAMA 270:2478-2486
Katz S (1983) Assessing self maintenance: activities of daily living, mobility and instrumental activities of daily living. J Am Geriatr Soc 31:721-727
Ridley SA, Wallace PGM (1990) Quality of life after intensive care. Anesthesia 45:808-813
Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American Multicenter study. JAMA 270:2957-2963
Thompson BT, Cox PN, Antonelli M, Carlet J, Cassel J, Hill NS, Hinds CJ, Pimentel JM, Reinhart K, Thijs LG (2004) Challenges in end-of-life care in the ICU: statement of the 5th International Consensus Conference in Critical Care: Brussels, Belgium, April 2003: executive summary. American Thoracic Society, European Respiratory Society; European Society of Intensive Care Medicine, Society of Critical Care Medicine, Societé de Réanimation de Langue Française Crit Care Med 32:1781-1784
Patrick DL, Danis M, Southerland LI, Hong G (1988) Quality of life after intensive care. J Gen Intern Med 3:218-223
Bucquet D, Condon S, Ritchie K (1990) The French version of the Nottingham Health Profile: a comparison of items weights with those of the source version. Soc Sci Med 30:829-837
Davis RB, Iezzoni Li, Phillips RS, Reiley P, Coffman GA, Safran C (1995) Predicting in-hospital mortality. The importance of functional status information. Med Care 33:906-921
Boumendil A, Aegerter P, Guidet B. Cub-Rea Network (2005) Treatment intensity and outcome of patients aged 80 and older in intensive care units: a matched-cohort study. J Am Geriatr Soc 53:88-93
Rady MY, Johnson DJ (2004) Hospital discharge to care facility. A patient-centered outcome for the evaluation of intensive care for octogenarians. Chest 126:1583-1591
Azoulay E, Pochard F, Garrouste-Orgeas M, Moreau D, Montesino L, Adrie C, De Lassence A, Cohen Y, Timsit JF for the Outcomerea group (2003) Decisions to forgo life-sustaining therapy in ICU patients independently predicts hospital death. Intensive Care Med 29:1895-1901
Cohen L, Lambrinos J (1995) Investigating the impact of age of mechanical ventilation using a population of 41848 patients from a statewide database. Chest 107:1673-1680
Mayer-Oakes S, Oye R, Leake B (1991) Predictors of mortality in older patients following medical intensive care. J Am Geriatr Soc 39:862-868
Rosenthal GE, Kaboli PJ, Barnett MJ, Sirio CA (2002) Age and risk of in-hospital death: insights from a multi-hospital study of intensive care patients. J Am Geriatr Soc 50:1205-1212
Wright JC, Plenderleith L, Ridley SA (2003) Long term survival following intensive care: subgroup analysis and comparison with the general population. Anaesthesia 58:637-642
Niskanen M, Ruokonen E, Takala J, Rissanen P, Kari A (1999) Quality of care after prolonged intensive care. Crit Care Med 27:1132-1138
Graf J, Koch M, Dujardin R, Kersten A, Janssens U (2003) Health-related quality of life before, 1 month after, and 9 months after intensive care in medical cardiovascular and pulmonary patients. Crit Care Med 31:2163-2169
Nierman DM, Schlechter CB, Cannon LM, Meier DE (2001) Outcome prediction model for very elderly critically ill patients. Crit Care Med 29:1853-1859
Montuclard L, Garrouste-Orgeas M, Timsit JF, Misset B, De Jonghe B, Carlet J (2000) Outcome, functional autonomy, and quality of life of elderly patients with a long term intensive care unit stay. Crit Care Med 28:3389-3395
