Death in Emergency Departments: a Multicenter Cross-sectional Survey with Analysis of Withholding and Withdrawing Life Support

Overview

Journal Intensive Care Med

Specialty Critical Care

Date 2010 Mar 16

PMID 20229044

Citations 35

Authors

Philippe Le Conte

David Riochet

Eric Batard

Christelle Volteau

Bruno Giraudeau

Idriss Arnaudet

Laetitia Labastire

Jacques Levraut

Frederic Thys

Dominique Lauque

Claude Piva

Jeannot Schmidt

David Trewick

Gilles Potel

Affiliations

Soon will be listed here.

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.

Citing Articles

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