• Critical care medicine · Jan 2012

    Multicenter Study

    The Eldicus prospective, observational study of triage decision making in European intensive care units. Part II: intensive care benefit for the elderly.

    • Charles L Sprung, Antonio Artigas, Jozef Kesecioglu, Angelo Pezzi, Joergen Wiis, Romain Pirracchio, Mario Baras, David L Edbrooke, Antonio Pesenti, Jan Bakker, Chris Hargreaves, Gabriel Gurman, Simon L Cohen, Anne Lippert, Didier Payen, Davide Corbella, and Gaetano Iapichino.
    • Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel. charles.sprung@ekmd.huji.ac.il
    • Crit. Care Med.. 2012 Jan 1;40(1):132-8.

    RationaleLife and death triage decisions are made daily by intensive care unit physicians. Admission to an intensive care unit is denied when intensive care unit resources are constrained, especially for the elderly.ObjectiveTo determine the effect of intensive care unit triage decisions on mortality and intensive care unit benefit, specifically for elderly patients.DesignProspective, observational study of triage decisions from September 2003 until March 2005.SettingEleven intensive care units in seven European countries.PatientsAll patients >18 yrs with an explicit request for intensive care unit admission.InterventionsAdmission or rejection to intensive care unit.Measurements And Main ResultsDemographic, clinical, hospital, physiologic variables, and 28-day mortality were obtained on consecutive patients. There were 8,472 triages in 6,796 patients, 5,602 (82%) were accepted to the intensive care unit, 1,194 (18%) rejected; 3,795 (49%) were ≥ 65 yrs. Refusal rate increased with increasing patient age (18-44: 11%; 45-64: 15%; 65-74: 18%; 75-84: 23%; >84: 36%). Mortality was higher for older patients (18-44: 11%; 45-64: 21%; 65-74: 29%; 75-84: 37%; >84: 48%). Differences between mortalities of accepted vs. rejected patients, however, were greatest for older patients (18-44: 10.2% vs. 12.5%; 45-64: 21.2% vs. 22.3%; 65-74: 27.9% vs. 34.6%; 75-84: 35.5% vs. 40.4%; >84: 41.5% vs. 58.5%). Logistic regression showed a greater mortality reduction for accepted vs. rejected patients corrected for disease severity for elderly patients (age >65 [odds ratio 0.65, 95% confidence interval 0.55-0.78, p < .0001]) than younger patients (age <65 [odds ratio 0.74, 95% confidence interval 0.57-0.97, p = .01]).ConclusionsDespite the fact that elderly patients have more intensive care unit rejections than younger patients and have a higher mortality when admitted, the mortality benefit appears greater for the elderly. Physicians should consider changing their intensive care unit triage practices for the elderly.

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