Tags

Type your tag names separated by a space and hit enter

Treatment limitations at admission to intensive care units in Australia and New Zealand: prevalence, outcomes, and resource use*.
Crit Care Med. 2012 Jul; 40(7):2082-9.CC

Abstract

BACKGROUND

Previous studies have addressed patients in whom treatment is withheld or withdrawn after a period of intensive care unit management. However, no studies have investigated the epidemiology of patients with treatment limitations in place at the time of intensive care unit admission.

OBJECTIVE

To report the epidemiology and outcome of patients with treatment limitations at intensive care unit admission and to identify characteristics associated with survival and discharge to home.

DESIGN

Retrospective database study using data from the Australian and New Zealand Intensive Care Society Adult Patient Database.

SETTING

Australian and New Zealand intensive care units.

PATIENTS

One hundred eighty-seven thousand four hundred and one intensive care patients collected over a 3-yr period, 5,989 (3.2%) of whom had treatment limitations at admission to the intensive care unit.

INTERVENTIONS

Retrospective database study with no interventions. Data collected included patient characteristics, length of stay, mortality, and discharge destination. Mean intensive care unit bed days were used as a surrogate for resource consumption.

MEASUREMENTS AND MAIN RESULTS

Between January 1, 2007, and December 31, 2009, 5,989 (3.2%) patients were reported to the Australia and New Zealand Intensive Care Society Adult Patient Database who had treatment limitation orders at admission to intensive care unit. Mortality was 53% (95% confidence interval 51.7%-54.3%) compared with 9% (95% confidence interval 8.9%-9.1%) in patients admitted for full active management (p ≤ .001). Overall, 30% of patients with treatment limitations were discharged directly to their homes. Intensive care unit bed day usage was similar between the two groups. Within the treatment limitation group, younger patients, those with less comorbid diseases, less acute physiological disturbance, and those admitted following elective surgery, were more likely to survive and be discharged home. Admission diagnosis was an important determinant of outcome with intracranial or subarachnoid hemorrhage predicting a extremely high mortality.

CONCLUSIONS

Patients with treatment limitations on intensive care unit admission comprise approximately 2,000 patients per year in Australia and New Zealand. Despite such limitations, almost half of these patients survive their hospital admission and a third return directly to their home.

Authors+Show Affiliations

Department of Intensive CareThe Alfred Hospital, Melbourne, Victoria, Australia. gepgodfrey@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22584761

Citation

Godfrey, George, et al. "Treatment Limitations at Admission to Intensive Care Units in Australia and New Zealand: Prevalence, Outcomes, and Resource Use*." Critical Care Medicine, vol. 40, no. 7, 2012, pp. 2082-9.
Godfrey G, Pilcher D, Hilton A, et al. Treatment limitations at admission to intensive care units in Australia and New Zealand: prevalence, outcomes, and resource use*. Crit Care Med. 2012;40(7):2082-9.
Godfrey, G., Pilcher, D., Hilton, A., Bailey, M., Hodgson, C. L., & Bellomo, R. (2012). Treatment limitations at admission to intensive care units in Australia and New Zealand: prevalence, outcomes, and resource use*. Critical Care Medicine, 40(7), 2082-9. https://doi.org/10.1097/CCM.0b013e31824ea045
Godfrey G, et al. Treatment Limitations at Admission to Intensive Care Units in Australia and New Zealand: Prevalence, Outcomes, and Resource Use*. Crit Care Med. 2012;40(7):2082-9. PubMed PMID: 22584761.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment limitations at admission to intensive care units in Australia and New Zealand: prevalence, outcomes, and resource use*. AU - Godfrey,George, AU - Pilcher,David, AU - Hilton,Andrew, AU - Bailey,Michael, AU - Hodgson,Carol L, AU - Bellomo,Rinaldo, PY - 2012/5/16/entrez PY - 2012/5/16/pubmed PY - 2012/9/26/medline SP - 2082 EP - 9 JF - Critical care medicine JO - Crit. Care Med. VL - 40 IS - 7 N2 - BACKGROUND: Previous studies have addressed patients in whom treatment is withheld or withdrawn after a period of intensive care unit management. However, no studies have investigated the epidemiology of patients with treatment limitations in place at the time of intensive care unit admission. OBJECTIVE: To report the epidemiology and outcome of patients with treatment limitations at intensive care unit admission and to identify characteristics associated with survival and discharge to home. DESIGN: Retrospective database study using data from the Australian and New Zealand Intensive Care Society Adult Patient Database. SETTING: Australian and New Zealand intensive care units. PATIENTS: One hundred eighty-seven thousand four hundred and one intensive care patients collected over a 3-yr period, 5,989 (3.2%) of whom had treatment limitations at admission to the intensive care unit. INTERVENTIONS: Retrospective database study with no interventions. Data collected included patient characteristics, length of stay, mortality, and discharge destination. Mean intensive care unit bed days were used as a surrogate for resource consumption. MEASUREMENTS AND MAIN RESULTS: Between January 1, 2007, and December 31, 2009, 5,989 (3.2%) patients were reported to the Australia and New Zealand Intensive Care Society Adult Patient Database who had treatment limitation orders at admission to intensive care unit. Mortality was 53% (95% confidence interval 51.7%-54.3%) compared with 9% (95% confidence interval 8.9%-9.1%) in patients admitted for full active management (p ≤ .001). Overall, 30% of patients with treatment limitations were discharged directly to their homes. Intensive care unit bed day usage was similar between the two groups. Within the treatment limitation group, younger patients, those with less comorbid diseases, less acute physiological disturbance, and those admitted following elective surgery, were more likely to survive and be discharged home. Admission diagnosis was an important determinant of outcome with intracranial or subarachnoid hemorrhage predicting a extremely high mortality. CONCLUSIONS: Patients with treatment limitations on intensive care unit admission comprise approximately 2,000 patients per year in Australia and New Zealand. Despite such limitations, almost half of these patients survive their hospital admission and a third return directly to their home. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/22584761/Treatment_limitations_at_admission_to_intensive_care_units_in_Australia_and_New_Zealand:_prevalence_outcomes_and_resource_use__ L2 - https://dx.doi.org/10.1097/CCM.0b013e31824ea045 DB - PRIME DP - Unbound Medicine ER -