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Intensive Care Med. 2010 May;36(5):765-72. doi: 10.1007/s00134-010-1800-1. Epub 2010 Mar 13.

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

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  • 1Department of Emergency Medicine, Nantes University Hospital, Nantes Cedex 01, France. philippe.leconte@chu-nantes.fr

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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PMID:
20229044
[PubMed - indexed for MEDLINE]
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