Death in emergency departments: a multicenter cross-sectional survey with analysis of withholding and withdrawing life support
(2010) Intensive Care Medicine — Vol. 36, n° 5, p. 765-772 (2010)
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- Abstract
- To describe the characteristics of patients who die in emergency departments and the decisions to withhold or withdraw life support. 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. 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 +/- A 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%). 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.
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Le Conte, P., Thys, F., Riochet, D., Batard, E., Volteau, C., Giraudeau, B., Arnaudet, I., Labastire, L., Levraut, J., Lauque, D., Piva, C., Schmidt, J., Trewick, D., & Potel, G. (2010). Death in emergency departments: a multicenter cross-sectional survey with analysis of withholding and withdrawing life support. Intensive Care Medicine, 36(5), 765-772. https://doi.org/10.1007/s00134-010-1800-1 (Original work published 2010)