Edward G Seferian1, Bekele Afessa. 1. Division of Pediatric Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA. seferian.edward@mayo.edu
Abstract
OBJECTIVES: To determine population-based rates of intensive care unit (ICU) use at the end of life in adults and describe demographic and clinical variation in end-of-life ICU use. PATIENTS AND METHODS: A retrospective, population-based cohort study set in Olmsted County, Minnesota, was performed. We identified adult residents admitted to an ICU in 1998 and determined those who were in the last year of life. Demographic data, ICU admission diagnoses, ICU Interventions, and length of stay were collected. We obtained Charlson comorbidity diagnoses and Indices for residents of Olmsted County to calculate condition-specific rates of end-of-life ICU use. RESULTS: Of the 818 residents who had an ICU admission in 1998, 90 died in either the ICU or the hospital after having received ICU care. One in 8 decedents from Olmsted County in 1998 received ICU care during a terminal hospital admission. Six-month decedents who had received ICU care were older, had longer lengths of stay, and had a higher degree of comorbid illness compared with 6-month survivors. The ICU admission rates in the last 6 months of life increased with age and number of chronic conditions, ranging from 0.26 per 1000 person-years in the 18- to 44-year-old group to 18.5 per 1000 person-years in those 85 years or older and from 0.34 per 1000 person-years in those with no chronic conditions to 302.1 per 1000 person-years in those with 5 or more chronic conditions. CONCLUSION: The rate of ICU use at the end of life Increases significantly with age and with the number of coexisting chronic illnesses.
OBJECTIVES: To determine population-based rates of intensive care unit (ICU) use at the end of life in adults and describe demographic and clinical variation in end-of-life ICU use. PATIENTS AND METHODS: A retrospective, population-based cohort study set in Olmsted County, Minnesota, was performed. We identified adult residents admitted to an ICU in 1998 and determined those who were in the last year of life. Demographic data, ICU admission diagnoses, ICU Interventions, and length of stay were collected. We obtained Charlson comorbidity diagnoses and Indices for residents of Olmsted County to calculate condition-specific rates of end-of-life ICU use. RESULTS: Of the 818 residents who had an ICU admission in 1998, 90 died in either the ICU or the hospital after having received ICU care. One in 8 decedents from Olmsted County in 1998 received ICU care during a terminal hospital admission. Six-month decedents who had received ICU care were older, had longer lengths of stay, and had a higher degree of comorbid illness compared with 6-month survivors. The ICU admission rates in the last 6 months of life increased with age and number of chronic conditions, ranging from 0.26 per 1000 person-years in the 18- to 44-year-old group to 18.5 per 1000 person-years in those 85 years or older and from 0.34 per 1000 person-years in those with no chronic conditions to 302.1 per 1000 person-years in those with 5 or more chronic conditions. CONCLUSION: The rate of ICU use at the end of life Increases significantly with age and with the number of coexisting chronic illnesses.