Article (Scientific journals)
Predictors of intensive care unit refusal in French intensive care units: a multiple-center study.
Garrouste-Orgeas, Maite; Montuclard, Luc; Timsit, Jean-Francois et al.
2005In Critical Care Medicine, 33 (4), p. 750-5
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Keywords :
Female; France/epidemiology; Hospital Bed Capacity/statistics & numerical data; Hospital Mortality; Hospitals, Urban/statistics & numerical data; Humans; Intensive Care Units/organization & administration/statistics & numerical data; Logistic Models; Male; Middle Aged; Patient Admission/statistics & numerical data; Prospective Studies; Refusal to Treat/statistics & numerical data; Risk Factors; Treatment Refusal/statistics & numerical data; Triage/statistics & numerical data
Abstract :
[en] OBJECTIVE: To identify factors associated with granting or refusing intensive care unit (ICU) admission, to analyze ICU characteristics and triage decisions, and to describe mortality in admitted and refused patients. DESIGN: Observational, prospective, multiple-center study. SETTING: Four university hospitals and seven primary-care hospitals in France. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Age, underlying diseases (McCabe score and Knaus class), dependency, hospital mortality, and ICU characteristics were recorded. The crude ICU refusal rate was 23.8% (137/574), with variations from 7.1% to 63.1%. The reasons for refusal were too well to benefit (76/137, 55.4%), too sick to benefit (51/137, 37.2%), unit too busy (9/137, 6.5%), and refusal by the family (1/137). In logistic regression analyses, two patient-related factors were associated with ICU refusal: dependency (odds ratio [OR], 14.20; 95% confidence interval [CI], 5.27-38.25; p < .0001) and metastatic cancer (OR, 5.82; 95% CI, 2.22-15.28). Other risk factors were organizational, namely, full unit (OR, 3.16; 95% CI, 1.88-5.31), center (OR, 3.81; 95% CI, 2.27-6.39), phone admission (OR, 0.23; 95% CI, 0.14-0.40), and daytime admission (OR, 0.52; 95% CI, 0.32-0.84). The Standardized Mortality Ratio was 1.41 (95% CI, 1.19-1.69) for immediately admitted patients, 1.75 (95% CI, 1.60-1.84) for refused patients, and 1.03 (95% CI, 0.28-1.75) for later-admitted patients. CONCLUSIONS: ICU refusal rates varied greatly across ICUs and were dependent on both patient and organizational factors. Efforts to define ethically optimal ICU admission policies might lead to greater homogeneity in refusal rates, although case-mix variations would be expected to leave an irreducible amount of variation across ICUs.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Garrouste-Orgeas, Maite
Montuclard, Luc
Timsit, Jean-Francois
Reignier, Jean
Desmettre, Thibault
Karoubi, Philippe
Moreau, Delphine
Montesino, Laurent
Duguet, Alexandre
Boussat, Sandrine
Ede, Christophe
Monseau, Yannick
Paule, Thierry
Misset, Benoît ;  Centre Hospitalier Universitaire de Liège - CHU > Service de Soins Intensifs
Carlet, Jean
More authors (5 more) Less
Language :
English
Title :
Predictors of intensive care unit refusal in French intensive care units: a multiple-center study.
Publication date :
2005
Journal title :
Critical Care Medicine
ISSN :
0090-3493
eISSN :
1530-0293
Publisher :
Lippincott Williams & Wilkins, United States - Pennsylvania
Volume :
33
Issue :
4
Pages :
750-5
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 21 February 2020

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