OBJECTIVES: To determine whether patients aged 80 and older have similar treatment intensity to that of younger patients in the intensive care unit (ICU). DESIGN: Multicenter, matched-cohort study. SETTING: Data were extracted from a multicenter database with 36 ICUs in the Paris area (France) during a 4-year period (1997-2000). PARTICIPANTS: Three thousand one hundred seventy-five patients aged 80 and older (oldest-old) were retrospectively matched to 3,175 patients aged 65 to 79 (young-old). MEASUREMENTS: The matching criteria were severity status on admission (+/-2) (assessed using a corrected Simplified Acute Physiology Score II leaving out age points), Charlson Comorbidity Index, type of admission (surgical vs medical), sex, admission to same ICU, and year of ICU admission. The underlying condition was classified using the McCabe classification. The functional status was assessed using the Knaus classification. The ICU workload was assessed using the OMEGA scoring system. RESULTS: Total and daily workload were lower in the oldest-old than in matched young-old patients. Estimated mean direct medical cost per stay was approximately 1,280 dollars lower for oldest-old patients. Older patients received less mechanical ventilation (adjusted odds ratio (AOR)=0.69, 95% confidence interval (CI)=0.61-0.78), less tracheostomy (AOR=0.37, 95% CI=0.28-0.50), and less renal support (AOR=0.52, 95% CI=0.41-0.66) than matched young-old patients. Oldest-old patients had a shorter length of ICU stay than matched young-old patients and the same length of post-ICU stay. CONCLUSION: Oldest-old patients receive less treatment in the ICU than young-old patients even after adjustment for severity of illness.
OBJECTIVES: To determine whether patients aged 80 and older have similar treatment intensity to that of younger patients in the intensive care unit (ICU). DESIGN: Multicenter, matched-cohort study. SETTING: Data were extracted from a multicenter database with 36 ICUs in the Paris area (France) during a 4-year period (1997-2000). PARTICIPANTS: Three thousand one hundred seventy-five patients aged 80 and older (oldest-old) were retrospectively matched to 3,175 patients aged 65 to 79 (young-old). MEASUREMENTS: The matching criteria were severity status on admission (+/-2) (assessed using a corrected Simplified Acute Physiology Score II leaving out age points), Charlson Comorbidity Index, type of admission (surgical vs medical), sex, admission to same ICU, and year of ICU admission. The underlying condition was classified using the McCabe classification. The functional status was assessed using the Knaus classification. The ICU workload was assessed using the OMEGA scoring system. RESULTS: Total and daily workload were lower in the oldest-old than in matched young-old patients. Estimated mean direct medical cost per stay was approximately 1,280 dollars lower for oldest-old patients. Older patients received less mechanical ventilation (adjusted odds ratio (AOR)=0.69, 95% confidence interval (CI)=0.61-0.78), less tracheostomy (AOR=0.37, 95% CI=0.28-0.50), and less renal support (AOR=0.52, 95% CI=0.41-0.66) than matched young-old patients. Oldest-old patients had a shorter length of ICU stay than matched young-old patients and the same length of post-ICU stay. CONCLUSION: Oldest-old patients receive less treatment in the ICU than young-old patients even after adjustment for severity of illness.
Authors: Gerald C Ihra; Judith Lehberger; Helene Hochrieser; Peter Bauer; Rene Schmutz; Barbara Metnitz; Philipp G H Metnitz Journal: Intensive Care Med Date: 2012-02-22 Impact factor: 17.440
Authors: Sean M Bagshaw; Neill K J Adhikari; Karen E A Burns; Jan O Friedrich; Josée Bouchard; Francois Lamontagne; Lauralyn A McIntrye; Jean-François Cailhier; Peter Dodek; Henry T Stelfox; Margaret Herridge; Stephen Lapinsky; John Muscedere; James Barton; Donald Griesdale; Mark Soth; Althea Ambosta; Gerald Lebovic; Ron Wald Journal: Clin J Am Soc Nephrol Date: 2019-03-21 Impact factor: 8.237
Authors: Emilio Sacanella; Joan Manel Pérez-Castejón; Josep Maria Nicolás; Ferran Masanés; Marga Navarro; Pedro Castro; Alfonso López-Soto Journal: Intensive Care Med Date: 2008-11-04 Impact factor: 17.440
Authors: Sean M Bagshaw; Steve A R Webb; Anthony Delaney; Carol George; David Pilcher; Graeme K Hart; Rinaldo Bellomo Journal: Crit Care Date: 2009-04-01 Impact factor: 9.097