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Intensive Care Med. 2003 May;29(5):774-81. Epub 2003 Apr 2.

Triaging patients to the ICU: a pilot study of factors influencing admission decisions and patient outcomes.

Author information

1
Medical-Surgical ICU, Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France. mgarrouste@hopital-saint-joseph.org

Abstract

OBJECTIVE:

To assess the appropriateness of ICU triage decisions. DESIGN. Prospective descriptive single-center study.

SETTING:

Ten-bed, medical-surgical ICU in an acute-care 460-bed, tertiary care hospital.

PATIENTS:

All patients triaged for admission were entered prospectively.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Age, underlying diseases, admission diagnoses, Mortality Probability Model (MPM0) score, information available to ICU physicians, and mortality were recorded. Of the 334 patients (96% medical), 145 (46.4%) were refused. Reasons for refusal were being too-sick-to-benefit (48, 14%) and too-well-to-benefit (93, 28%). Factors independently associated with refusal were patient location, ICU physician seniority, bed availability, patient age, underlying diseases, and disability. Hospital mortality was 23% and 27% for patients admitted to our ICU and other ICUs, respectively, and 7.5% and 60% for patients too well and too sick to benefit, respectively. In the multivariate Cox model, McCabe = 1 [hazard ratio (HR), 0.44 (95% CI, 0.24-0.77), P=0.001], living at home without help (HR, 0.440, 95% CI, 0.28-0.68, P=0.0003), and immunosuppression (HR, 1.91, 95% CI, 1.09-3.33, P=0.02) were independent predictors of hospital death. Neither later ICU admission nor refusal was associated with cohort survival. MPM0 was not associated with hospital mortality.

CONCLUSIONS:

Refusal of ICU admission was related to the ability of the triaging physician to examine the patient, ICU physician seniority, patient age, underlying diseases, self-sufficiency, and number of beds available. Specific training of junior physicians in triaging might bring further improvements. Scores that are more accurate than the MPM0 are needed.

PMID:
12677368
DOI:
10.1007/s00134-003-1709-z
[Indexed for MEDLINE]

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