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01-05-2010 | Original

Death in emergency departments: a multicenter cross-sectional survey with analysis of withholding and withdrawing life support

Authors: Philippe Le Conte, David Riochet, Eric Batard, Christelle Volteau, Bruno Giraudeau, Idriss Arnaudet, Laetitia Labastire, Jacques Levraut, Frédéric Thys, Dominique Lauque, Claude Piva, Jeannot Schmidt, David Trewick, Gilles Potel

Published in: Intensive Care Medicine | Issue 5/2010

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.

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Knaus’s class A: prior good health with no functional limitations; class B: mild to moderate limitation in activity because of chronic health problem; class C: chronic disease producing serious but not incapacitating restriction of activity; class D: severe restriction of activity due to disease, including bedridden.

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Title: Death in emergency departments: a multicenter cross-sectional survey with analysis of withholding and withdrawing life support
Authors: Philippe Le Conte
David Riochet
Eric Batard
Christelle Volteau
Bruno Giraudeau
Idriss Arnaudet
Laetitia Labastire
Jacques Levraut
Frédéric Thys
Dominique Lauque
Claude Piva
Jeannot Schmidt
David Trewick
Gilles Potel
Publication date: 01-05-2010
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 5/2010
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-010-1800-1

At a glance: The STEP trials

Springer Medicine

Death in emergency departments: a multicenter cross-sectional survey with analysis of withholding and withdrawing life support

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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