[en] OBJECTIVE: To assess the appropriateness of ICU triage decisions. DESIGN. Prospective descriptive single-center study. SETTING: Ten-bed, medical-surgical ICU in an acute-care 460-bed, tertiary care hospital. PATIENTS: All patients triaged for admission were entered prospectively. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Age, underlying diseases, admission diagnoses, Mortality Probability Model (MPM0) score, information available to ICU physicians, and mortality were recorded. Of the 334 patients (96% medical), 145 (46.4%) were refused. Reasons for refusal were being too-sick-to-benefit (48, 14%) and too-well-to-benefit (93, 28%). Factors independently associated with refusal were patient location, ICU physician seniority, bed availability, patient age, underlying diseases, and disability. Hospital mortality was 23% and 27% for patients admitted to our ICU and other ICUs, respectively, and 7.5% and 60% for patients too well and too sick to benefit, respectively. In the multivariate Cox model, McCabe = 1 [hazard ratio (HR), 0.44 (95% CI, 0.24-0.77), P=0.001], living at home without help (HR, 0.440, 95% CI, 0.28-0.68, P=0.0003), and immunosuppression (HR, 1.91, 95% CI, 1.09-3.33, P=0.02) were independent predictors of hospital death. Neither later ICU admission nor refusal was associated with cohort survival. MPM0 was not associated with hospital mortality. CONCLUSIONS: Refusal of ICU admission was related to the ability of the triaging physician to examine the patient, ICU physician seniority, patient age, underlying diseases, self-sufficiency, and number of beds available. Specific training of junior physicians in triaging might bring further improvements. Scores that are more accurate than the MPM0 are needed.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Garrouste-Orgeas, Maite
Montuclard, Luc
Timsit, Jean-Francois
Misset, Benoît ; Centre Hospitalier Universitaire de Liège - CHU > Service de Soins Intensifs
Christias, Marie
Carlet, Jean
Language :
English
Title :
Triaging patients to the ICU: a pilot study of factors influencing admission decisions and patient outcomes.
scite shows how a scientific paper has been cited by providing the context of the citation, a classification describing whether it supports, mentions, or contrasts the cited claim, and a label indicating in which section the citation was made.
Bibliography
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 international cohort of intensive care units patients. JAMA 270:2478-2486
Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG (1991) The APACHE III prognosis system: risk prediction of hospital mortality for critically ill hospitalized adults. Chest 100:1619-1636
Society of Critical Care Medicine Task Force on guidelines (1988) Recommendations for intensive care unit admissions and discharge criteria. Crit Care Med 16:807-808
Society of Critical Care Medicine Task Force on guidelines (1990) Consensus report on the ethics of foregoing life-sustaining treatments in the critically ill. Crit Care Med 18:1435-1439
Task force of the American college of Critical Care Medicine, Society of Critical Care Medicine (1999) Guidelines for intensive care unit admission, discharge, and triage. Crit Care Med 27:633-638
Azoulay E, Pochard F, Chevret S, Vinsonneau C, Garrouste M, Cohen Y (2001) Compliance with triage to intensive care recommendations. Crit Care Med 29:2132-2136
Sprung CL, Geber D, Eidelman LA, Baras M, Pizov R, Nimrod A, et al (1999) Evaluation of triage decisions for intensive care admission. Crit Care Med 27:1073-1079
McCabe WR, Jackson GG (1962) Gram-negative bacteremia: etiology and ecology. Arch Intern Med 110:847-855
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
Lemeshow S, Hosmer DW (1982) A review of goodness of fit statistics for use in the development of logistic regression model. Am J Epidemiol 115:92-106
Hanley JA, McNeil BJ (1983) A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148:839-843
Levin PD, Sprung CL (2001) The process of intensive care triage. Intensive Care Med 27:1441-1445
Joynt GM, Gomersall CD, Tan P, Lee A, Ai Yu Cheng C, Lai Yi Wong E (2001) Prospective evaluation of patients refused admission to an intensive care unit: triage, futility and outcome. Intensive Care Med 27:1459-1465
Frisho-Lima P, Gurman G, Schapira A, Porath A (1994) Rationing critical care: what happens to patients who are not admitted? Theor Surg 9:208-211
Kruse JA, Thill-Baharozian MC, Carlson RW (1989) Comparison of clinical assessment with APACHE II for predicting mortality risk in patients admitted to a medical intensive care unit. JAMA 260:1739-1742
Brannen AL II, Godfrey LJ, Goetter WE (1989) Prediction of outcome from critical illness. A comparison of clinical judgment with a prediction rule. Arch Intern Med 149:1083-1086
Lemeshow S, Le Gall JR (1994) Modeling the severity of illness of ICU patients. A system update. JAMA 272:1049-1055
Rodriguez RM, Wang E, Pearl RG (1997) Prediction of poor outcome of intensive care unit patients admitted from the emergency department. Crit Care Med 25:1801-1806
Fried TR, Bradley EH, Towle VR, Phil M, Allore H (2002) Understanding the treatment preferences of seriously ill patients. N Engl J Med 346:1061-1066
Uhlmann TR, Pearlman RA (1991) Perceived quality of life and preferences for life-sustaining treatment in older adults. Arch Intern Med 151:495-497
Konopad E, Noseworthy TW, Johnston R, Shustack A, Grace M (1995) Quality of life measures before and one year after admission to an intensive care unit. Crit Care Med 23:1653-1659
Brooks R, Kerridge R, Hillman K, Bauman A, Daffurn K (1997) Quality of life outcomes after intensive care: comparison with a community group. Intensive Care Med 23:581-586
Zaren B, Hedstrand U (1987) Quality of life among long terms survivors of intensive care. Crit Care Med 15:743-747
Gopal I, Bhonagiri S, Ronco C, Bellomo R (1997) Out of hospital outcome and quality of life in survivors of combined multiple organ and renal failures with continuous veno-venous hemofiltration/hemodiafiltration. Intensive Care Med 23:766-772
Keenan SP, Dodek P, Chan K, Hogg RS, Craib KJ, Anis AH, Spinelli JJ (2002) Intensive care unit admission has minimal impact on long-term mortality. Crit Care Med 30:501-507
Similar publications
Sorry the service is unavailable at the moment. Please try again later.
This website uses cookies to improve user experience. Read more
Save & Close
Accept all
Decline all
Show detailsHide details
Cookie declaration
About cookies
Strictly necessary
Performance
Strictly necessary cookies allow core website functionality such as user login and account management. The website cannot be used properly without strictly necessary cookies.
This cookie is used by Cookie-Script.com service to remember visitor cookie consent preferences. It is necessary for Cookie-Script.com cookie banner to work properly.
Performance cookies are used to see how visitors use the website, eg. analytics cookies. Those cookies cannot be used to directly identify a certain visitor.
Used to store the attribution information, the referrer initially used to visit the website
Cookies are small text files that are placed on your computer by websites that you visit. Websites use cookies to help users navigate efficiently and perform certain functions. Cookies that are required for the website to operate properly are allowed to be set without your permission. All other cookies need to be approved before they can be set in the browser.
You can change your consent to cookie usage at any time on our Privacy Policy page.