Death in emergency departments: a multicenter cross-sectional survey with analysis of withholding and withdrawing life support.
Intensive Care Med
; 36(5): 765-72, 2010 May.
Article
in En
| MEDLINE
| ID: mdl-20229044
ABSTRACT
PURPOSE:
To describe the characteristics of patients who die in emergency departments and the decisions to withhold or withdraw life support.METHODS:
We undertook a 4-month prospective survey in 174 emergency departments in France and Belgium to describe patients who died and the decisions to limit life-support therapies.RESULTS:
Of 2,512 patients enrolled, 92 (3.7%) were excluded prior to analysis because of missing data; 1,196 were men and 1,224 were women (mean age 77.3 +/- 15 years). Of patients, 1,970 (81.4%) had chronic underlying diseases, and 1,114 (46%) had a previous functional limitation. Principal acute presenting disorders were cardiovascular, neurological, and respiratory. Life-support therapy was initiated in 1,781 patients (73.6%). Palliative care was undertaken for 1,373 patients (56.7%). A decision to withhold or withdraw life-sustaining treatments was taken for 1,907 patients (78.8%) and mostly concerned patients over 80 years old, with underlying metastatic cancer or previous functional limitation. Decisions were discussed with family or relatives in 58.4% of cases. The decision was made by a single ED physician in 379 cases (19.9%), and by at least two ED physicians in 1,528 cases (80.1%).CONCLUSIONS:
Death occurring in emergency departments mainly concerned elderly patients with multiple chronic diseases and was frequently preceded by a decision to withdraw and/or withhold life-support therapies. Training of future ED physicians must be aimed at improving the level of care of dying patients, with particular emphasis on collegial decision-taking and institution of palliative care.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Terminally Ill
/
Withholding Treatment
/
Emergency Service, Hospital
Type of study:
Observational_studies
/
Prevalence_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Aged
/
Aged80
/
Female
/
Humans
/
Male
Country/Region as subject:
Europa
Language:
En
Journal:
Intensive Care Med
Year:
2010
Type:
Article
Affiliation country:
France