Neil R Orford1, Sharyn L Milnes2, Nigel Lambert2, Laura Berkeley2, Stephen E Lane3, Nicholas Simpson2, Tania Elderkin2, Allison Bone2, Peter Martin4, Charlie Corke2, Rinaldo Bellomo5, Michael Bailey5. 1. Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia. neilo@barwonhealth.org.au. 2. Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia. 3. Southern GP Training, Drysdale Clinic, Geelong, VIC, Australia. 4. Palliative Care Unit, Barwon Health, Geelong, VIC, Australia. 5. Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Abstract
OBJECTIVE: To describe the prevalence, characteristics, long-term outcomes and goals-of-care discussions of patients with objective indicators of life-limiting illnesses (LLIs) referred to the intensive care unit. DESIGN, SETTING AND PATIENTS: A prospective, observational, cohort study of all adult inpatients referred to the ICU by the medical emergency team or by direct referral, during the period 30 August 2012 to 1 February 2013, at a tertiary teaching hospital in Australia. MAIN OUTCOME MEASURES: Mortality, LLIs, discharge destination and documentation on goals of care in medical record. RESULTS: A total of 649 of 1024 patients referred to the ICU had an LLI, and only 34.4% of these patients had goals of care documented. Overall, 49.2% were admitted to the ICU, 48.4% were discharged home, and the 1-year mortality was 35.1%. The most common LLI criteria were heart disease (52.2%), chronic obstructive pulmonary disease (24.8%) and frailty (23.7%). The highest 1-year mortality was associated with pre-hospital residence in a nursing home (64.9%), dementia (63.3%), cancer (60.8%) and frailty (50.6%). Analysis of patients by clinical trajectory showed that 1-year mortality was significantly higher for patients with cancer (59.6%), combined organ failure and frailty (47.3%), frailty (43.8%) and organ failure (23.6%), compared with patients with no LLI (P < 0.0001). CONCLUSIONS: A high proportion of patients referred to the ICU have an LLI, and this is associated with prolonged hospital length of stay and a high 1-year mortality, and only one-quarter have documented discussions on goals of care. Patients with cancer-related and frailty-related LLIs have the worst survival trajectories.
OBJECTIVE: To describe the prevalence, characteristics, long-term outcomes and goals-of-care discussions of patients with objective indicators of life-limiting illnesses (LLIs) referred to the intensive care unit. DESIGN, SETTING AND PATIENTS: A prospective, observational, cohort study of all adult inpatients referred to the ICU by the medical emergency team or by direct referral, during the period 30 August 2012 to 1 February 2013, at a tertiary teaching hospital in Australia. MAIN OUTCOME MEASURES: Mortality, LLIs, discharge destination and documentation on goals of care in medical record. RESULTS: A total of 649 of 1024 patients referred to the ICU had an LLI, and only 34.4% of these patients had goals of care documented. Overall, 49.2% were admitted to the ICU, 48.4% were discharged home, and the 1-year mortality was 35.1%. The most common LLI criteria were heart disease (52.2%), chronic obstructive pulmonary disease (24.8%) and frailty (23.7%). The highest 1-year mortality was associated with pre-hospital residence in a nursing home (64.9%), dementia (63.3%), cancer (60.8%) and frailty (50.6%). Analysis of patients by clinical trajectory showed that 1-year mortality was significantly higher for patients with cancer (59.6%), combined organ failure and frailty (47.3%), frailty (43.8%) and organ failure (23.6%), compared with patients with no LLI (P < 0.0001). CONCLUSIONS: A high proportion of patients referred to the ICU have an LLI, and this is associated with prolonged hospital length of stay and a high 1-year mortality, and only one-quarter have documented discussions on goals of care. Patients with cancer-related and frailty-related LLIs have the worst survival trajectories.
Authors: Alison M Uyeda; J Randall Curtis; Ruth A Engelberg; Lyndia C Brumback; Yue Guo; James Sibley; William B Lober; Trevor Cohen; Janaki Torrence; Joanna Heywood; Sudiptho R Paul; Erin K Kross; Robert Y Lee Journal: J Pain Symptom Manage Date: 2022-02-16 Impact factor: 5.576
Authors: Moira O'Connor; Kaaren J Watts; Warren D Kilburn; Kitty Vivekananda; Claire E Johnson; Sharon Keesing; Georgia K B Halkett; Josephine Shaw; Valerie Colgan; Kevin Yuen; Renate Jolly; Simon C Towler; Anupam Chauhan; Margherita Nicoletti; Anton D Leonard Journal: J Gen Intern Med Date: 2020-10-09 Impact factor: 5.128