Limitación del ingreso en unidades de cuidados intensivos desde los servicios de urgencias y las plantas de hospitalización / Limiting ICU admission from emergency services and wards

Introducción: Las decisiones de no ingresar a un paciente en las unidades de cuidados intensivos (UCI) como forma de limitación de un tratamiento de soporte vital (LTSV) es una práctica que puede afectar al funcionamiento de los servicios de urgencias y a la forma en que los pacientes mueren.MétodosAnálisis post hoc del estudio ADENI-UCI. La principal variable analizada fue el motivo de negación de ingreso en UCI como medida de LTSV. Para el presente análisis post hoc se dividió a los enfermos registrados en 2 grupos: los enfermos consultados al servicio de medicina intensiva desde el área de urgencias y los pacientes consultados desde las áreas de hospitalización convencionales. En la estadística comparativa se utilizó la t de Student cuando se compararon los valores medios de las subcohortes de pacientes. Las variables categóricas se compararon con las pruebas de la χ2.ResultadosEl estudio ADENI-UCI incluía 2284 decisiones de no ingreso en UCI como medida de LTSV. La pobre calidad de vida estimada (p=0,0158), la presencia de enfermedad crónica grave (p=0,0169) y la futilidad de los tratamientos (p=0,0006) fueron decisiones porcentualmente con más peso dentro de la población de pacientes hospitalizados. El porcentaje de desacuerdo entre el médico consultor y el intensivista fue menor de forma significativa en los enfermos valorados desde los servicios de urgencias (p=0,0021).ConclusionesExisten diferencias apreciables en los motivos de consulta, así como en los de rechazo de ingreso en una UCI entre las consultas realizadas desde un servicio de urgencias y una planta de hospitalización convencional. (AU)

Introduction: Decisions not to admit a patient to intensive care units (ICU) as a way of limiting life support treatment (LLST) is a practice that can affect the operation of the emergency services and the way in which patients die.MethodsPost hoc analysis of the ADENI-UCI study. The main variable analysed was the reason for refusal of admission to the ICU as a measure of LLST. For the present post hoc analysis, the registered patients were divided into 2 groups: the patients assessed in the intensive medicine services from the emergency department and the patients assessed from the conventional hospitalization areas. Student t was used in the comparative statistics when the mean values of the patient sub-cohorts were compared. Categorical variables were compared with the χ2 tests.ResultsThe ADENI-ICU study included 2,284 decisions not to admit to the ICU as a measure of LLST. Estimated poor quality of life (p=.0158), the presence of severe chronic disease (P=.0169) and futility of treatment (P=.0006) were percentage decisions with greater weight within the population of hospitalized patients. The percentage of disagreement between the consulting physician and the intensivist was significantly lower in patients assessed from the emergency services (P=.0021).ConclusionsThere are appreciable differences in the reasons for consultation, as well as in those for refusal of admission to an ICU between the consultations made from an emergency department and a conventional hospitalization facility. (AU)

[Decisiones de no ingreso en las Unidades de Cuidados Intensivos como medida de limitación de los tratamientos de soporte vital: variabilidad geográfica en España]. / Decisions of refusal intensive Care Units' admission as a measure of limitation of life support treatments: geographical variability in Spain.

From a post hoc analysis of the ADENI-UCI study (multicenter, observational, cohort, prospective study, with a follow-up period of 13 months, in 62 Intensive Medicine Services in Spain. geographical differences in the reason for denial of income in UCI as a LTSV measure are analyzed. A total of 2284 with an average age of 75.25 (12.45) years were included. 59.43% male. By means of multinominal regression adjusted by age, sex, APACHE and SOFA, was evident (by choosing the northern for reference) that age in the south was a less significantly exposed reason (OR: 0.48 (IC95%: 0.35-0.65). p.

Decisiones de no ingreso en las Unidades de Cuidados Intensivos como medida de limitación de los tratamientos de soporte vital: variabilidad geográfica en España / Decisions of refusal intensive Care Units’ admission as a measure of limitation of life support treatments: geographical variability in Spain

A través de un análisis post hoc del estudio ADENI-UCI (estudio multicéntrico, observacional, de co-hortes, prospectivo, con un período de seguimiento de 13 meses, en un total de 62 servicios de MedicinaIntensiva en España; se analizan las diferencias geográficas del motivo de negación de ingreso en UCI comomedida de LTSV. Se incluyeron 2284 pacientes con una edad media de 75,25 (12,45) años. El 59,43% varones.Mediante regresión multinominal ajustada por edad, sexo, APACHE II y SOFA, se evidenció (al elegir lazona norte como referencia) que la edad en la zona sur fue un motivo menos expuesto de forma significati-va (OR: 0.48 (IC95%: 0.35-0.65). p<0,001), que la enfermedad crónica severa era menos valorada en la zona mediterránea (OR: 0.70 (IC95%: 0.56-0.87). p=0,001), mientras que presentaba más peso en la zona centro(OR: 1.78 (IC95%: 1.43-2.23). p<0,001). La limitación funcional previa fue el motivo más esgrimido en regio-nes centro y sur (OR: 1.39, (IC95%: 1.12-1.72). p=0,002; OR: 1.50, (IC95%:1.15-1.94). p=0,002). Fue la futilidaden el tratamiento el motivo que mayores diferencias presentó entre las diversas regiones analizadas (dif:37,2%-68,8%). Por lo tanto, se puede concluir que existen diferencias geográficas en el territorio españolen las decisiones de rechazar el ingreso en una UCI como medida de LTSV, probablemente justificadas pordiferencias organizativas de los servicios de medicina intensiva participantes en el ADENI-UCI.(AU)

From a post hoc analysis of the ADENI-UCI study (multicenter, observational, cohort, prospective study,with a follow-up period of 13 months, in 62 Intensive Medicine Services in Spain. geographical differencesin the reason for denial of income in UCI as a LTSV measure are analyzed. A total of 2284 with an averageage of 75.25 (12.45) years were included. 59.43% male. By means of multinominal regression adjusted byage, sex, APACHE and SOFA, was evident (by choosing the northern for reference) that age in the southwas a less significantly exposed reason (OR: 0.48 (IC95%: 0.35-0.65). p<0.001), that severe chronic diseasewas less valued in the Mediterranean area (OR: 0.7% 0 (IC95%: 0.56-0.87). p-0.001), while it had moreweight in the central area (OR: 1.78 (95% CI: 1.43-2.23). The previous functional limitation was more raisedin central and southern regions (OR: 1.39, (IC95%: 1.12-1.72). p-0.002; OR:1.50, (IC95%:1.15-1.94). 0.002).It was futility in treatment that had the greatest differences between the various regions analysed (dif:37,2% - 68,8%). There are geographical differences in the Spanish territory in decisions to refuse entry intoan ICU as an LTSV measure, probably justified by organizational differences in intensive medicine servicesparticipating in the ADENI-UCI.(AU)

[Limiting ICU admission from emergency services and wards]. / Limitación del ingreso en unidades de cuidados intensivos desde los servicios de urgencias y las plantas de hospitalización.

INTRODUCTION: Decisions not to admit a patient to intensive care units (ICU) as a way of limiting life support treatment (LLST) is a practice that can affect the operation of the emergency services and the way in which patients die. METHODS: Post hoc analysis of the ADENI-UCI study. The main variable analysed was the reason for refusal of admission to the ICU as a measure of LLST. For the present post hoc analysis, the registered patients were divided into 2 groups: the patients assessed in the intensive medicine services from the emergency department and the patients assessed from the conventional hospitalization areas. Student t was used in the comparative statistics when the mean values of the patient sub-cohorts were compared. Categorical variables were compared with the χ2 tests. RESULTS: The ADENI-ICU study included 2,284 decisions not to admit to the ICU as a measure of LLST. Estimated poor quality of life (p=.0158), the presence of severe chronic disease (P=.0169) and futility of treatment (P=.0006) were percentage decisions with greater weight within the population of hospitalized patients. The percentage of disagreement between the consulting physician and the intensivist was significantly lower in patients assessed from the emergency services (P=.0021). CONCLUSIONS: There are appreciable differences in the reasons for consultation, as well as in those for refusal of admission to an ICU between the consultations made from an emergency department and a conventional hospitalization facility.