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.
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.
Authors: Agnes van der Heide; Luc Deliens; Karin Faisst; Tore Nilstun; Michael Norup; Eugenio Paci; Gerrit van der Wal; Paul J van der Maas Journal: Lancet Date: 2003-08-02 Impact factor: 79.321
Authors: Kei Ouchi; Naomi George; Jeremiah D Schuur; Emily L Aaronson; Charlotta Lindvall; Edward Bernstein; Rebecca L Sudore; Mara A Schonberg; Susan D Block; James A Tulsky Journal: Ann Emerg Med Date: 2019-02-13 Impact factor: 5.721
Authors: M Garrouste-Orgeas; A Tabah; A Vesin; F Philippart; A Kpodji; C Bruel; C Grégoire; A Max; J F Timsit; B Misset Journal: Intensive Care Med Date: 2013-06-14 Impact factor: 17.440