Effect of Systematic Intensive Care Unit Triage on Long-term Mortality Among Critically Ill Elderly Patients in France
| Autor: | Pierre Charestan, Youri Yordanov, Tabassome Simon, Maité Garrouste-Orgeas, Maxime Maignan, Maguy Woimant, Bertrand Galichon, Anabela Patzak, Guillaume Leblanc, Jean-Pierre Quenot, Benoit Doumenc, Muriel Fartoukh, Olivier Ganansia, Nicolas Javaud, Pauline Trognon, Bertrand Guidet, Sylvie Azerad, Caroline Thomas, Dominique Pateron, Ariane Boumendil, S. Delerme |
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| Rok vydání: | 2017 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty Time Factors Critical Care Critical Illness Health Status Population law.invention 03 medical and health sciences Patient Admission 0302 clinical medicine Quality of life Randomized controlled trial law Activities of Daily Living Outcome Assessment Health Care medicine Humans Hospital Mortality 030212 general & internal medicine Critical Care Outcomes education Aged Aged 80 and over 2. Zero hunger education.field_of_study business.industry Mortality rate 030208 emergency & critical care medicine General Medicine Emergency department Intensive care unit 3. Good health Intensive Care Units Relative risk Quality of Life Female France Triage business Program Evaluation |
| Zdroj: | JAMA. 318:1450 |
| ISSN: | 0098-7484 |
| DOI: | 10.1001/jama.2017.13889 |
| Popis: | Importance The high mortality rate in critically ill elderly patients has led to questioning of the beneficial effect of intensive care unit (ICU) admission and to a variable ICU use among this population. Objective To determine whether a recommendation for systematic ICU admission in critically ill elderly patients reduces 6-month mortality compared with usual practice. Design, Setting, and Participants Multicenter, cluster-randomized clinical trial of 3037 critically ill patients aged 75 years or older, free of cancer, with preserved functional status (Index of Independence in Activities of Daily Living ≥4) and nutritional status (absence of cachexia) who arrived at the emergency department of one of 24 hospitals in France between January 2012 and April 2015 and were followed up until November 2015. Interventions Centers were randomly assigned either to use a program to promote systematic ICU admission of patients (n=1519 participants) or to follow standard practice (n=1518 participants). Main Outcomes and Measures The primary outcome was death at 6 months. Secondary outcomes included ICU admission rate, in-hospital death, functional status, and quality of life (12-Item Short Form Health Survey, ranging from 0 to 100, with higher score representing better self-reported health) at 6 months. Results One patient withdrew consent, leaving 3036 patients included in the trial (median age, 85 [interquartile range, 81-89] years; 1361 [45%] men). Patients in the systematic strategy group had an increased risk of death at 6 months (45% vs 39%; relative risk [RR], 1.16; 95% CI, 1.07-1.26) despite an increased ICU admission rate (61% vs 34%; RR, 1.80; 95% CI, 1.66-1.95). After adjustments for baseline characteristics, patients in the systematic strategy group were more likely to be admitted to an ICU (RR, 1.68; 95% CI, 1.54-1.82) and had a higher risk of in-hospital death (RR, 1.18; 95% CI, 1.03-1.33) but had no significant increase in risk of death at 6 months (RR, 1.05; 95% CI, 0.96-1.14). Functional status and physical quality of life at 6 months were not significantly different between groups. Conclusions and Relevance Among critically ill elderly patients in France, a program to promote systematic ICU admission increased ICU use but did not reduce 6-month mortality. Additional research is needed to understand the decision to admit elderly patients to the ICU. Trial Registration clinicaltrials.gov Identifier:NCT01508819 |
| Databáze: | OpenAIRE |
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