Prognosis After Emergency Department Intubation to Inform Shared Decision Making
| Autor: | Rebecca L. Sudore, Guruprasad D Jambaulikar, Kei Ouchi, Naomi George, Mara A. Schonberg, Emily L. Aaronson, Samuel F. Hohmann, James A. Tulsky, Jeremiah D. Schuur, Daniel J. Pallin |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Decision Making Severity of Illness Index Article Cohort Studies 03 medical and health sciences 0302 clinical medicine Primary outcome medicine Intubation Intratracheal Intubation Humans 030212 general & internal medicine Hospital Mortality Aged Retrospective Studies Aged 80 and over business.industry 030208 emergency & critical care medicine Emergency department Middle Aged Confidence interval Survival Rate Cohort Emergency medicine Female Geriatrics and Gerontology business Index hospitalization Emergency Service Hospital |
| Popis: | Author(s): Ouchi, Kei; Jambaulikar, Guruprasad D; Hohmann, Samuel; George, Naomi R; Aaronson, Emily L; Sudore, Rebecca; Schonberg, Mara A; Tulsky, James A; Schuur, Jeremiah D; Pallin, Daniel J | Abstract: ObjectivesTo inform the shared decision-making process between clinicians and older adults and their surrogates regarding emergency intubation.DesignRetrospective cohort study.SettingMulticenter, emergency department (ED)-based cohort.ParticipantsAdults aged 65 and older intubated in the ED from 2008 to 2015 from 262 hospitals across the United States (g95% of U.S. nonprofit academic medical centers).MeasurementsOur primary outcome was age-specific in-hospital mortality. Secondary outcomes were age-specific odds of death after adjusting for race, comorbid conditions, admission diagnosis, hospital disposition, and geographic region.ResultsWe identified 41,463 ED intubation encounters and included 35,036 in the final analysis. Sixty-four percent were in non-Hispanic whites and 54% in women. Overall in-hospital mortality was 33% (95% confidence interval (CI)=34-35%). Twenty-four percent (95% CI=24-25%) of subjects were discharged to home, and 41% (95% CI=40-42%) were discharged to a location other than home. Mortality was 29% (95% CI=28-29%) for individuals aged 65 to 74, 34% (95% CI=33-35%) for those aged 75 to 79, 40% (95% CI=39-41%) for those aged 80 to 84, 43% (95% CI=41-44%) for those aged 85 to 89, and 50% (95% CI=48-51%) for those aged 90 and older.ConclusionAfter emergency intubation, 33% percent of older adults die during the index hospitalization. Only 24% of survivors are discharged to home. Simple, graphic representations of this information, in combination with an experienced clinician's overall clinical assessment, will support shared decision-making regarding unplanned intubation. |
| Databáze: | OpenAIRE |
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