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Predictors of intensive care unit refusal in French intensive care units: a multiple-center study.

Abstract：

OBJECTIVE:To identify factors associated with granting or refusing intensive care unit (ICU) admission, to analyze ICU characteristics and triage decisions, and to describe mortality in admitted and refused patients. DESIGN:Observational, prospective, multiple-center study. SETTING:Four university hospitals and seven primary-care hospitals in France. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Age, underlying diseases (McCabe score and Knaus class), dependency, hospital mortality, and ICU characteristics were recorded. The crude ICU refusal rate was 23.8% (137/574), with variations from 7.1% to 63.1%. The reasons for refusal were too well to benefit (76/137, 55.4%), too sick to benefit (51/137, 37.2%), unit too busy (9/137, 6.5%), and refusal by the family (1/137). In logistic regression analyses, two patient-related factors were associated with ICU refusal: dependency (odds ratio [OR], 14.20; 95% confidence interval [CI], 5.27-38.25; p < .0001) and metastatic cancer (OR, 5.82; 95% CI, 2.22-15.28). Other risk factors were organizational, namely, full unit (OR, 3.16; 95% CI, 1.88-5.31), center (OR, 3.81; 95% CI, 2.27-6.39), phone admission (OR, 0.23; 95% CI, 0.14-0.40), and daytime admission (OR, 0.52; 95% CI, 0.32-0.84). The Standardized Mortality Ratio was 1.41 (95% CI, 1.19-1.69) for immediately admitted patients, 1.75 (95% CI, 1.60-1.84) for refused patients, and 1.03 (95% CI, 0.28-1.75) for later-admitted patients. CONCLUSIONS:ICU refusal rates varied greatly across ICUs and were dependent on both patient and organizational factors. Efforts to define ethically optimal ICU admission policies might lead to greater homogeneity in refusal rates, although case-mix variations would be expected to leave an irreducible amount of variation across ICUs.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Garrouste-Orgeas M,Montuclard L,Timsit JF,Reignier J,Desmettre T,Karoubi P,Moreau D,Montesino L,Duguet A,Boussat S,Ede C,Monseau Y,Paule T,Misset B,Carlet J,French ADMISSIONREA Study Group.

doi

10.1097/01.ccm.0000157752.26180.f1

subject

Has Abstract

pub_date

2005-04-01 00:00:00

pages

750-5

issue

eissn

0090-3493

issn

1530-0293

pii

00003246-200504000-00009

journal_volume

pub_type

杂志文章,多中心研究

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Predictors of intensive care unit refusal in French intensive care units: a multiple-center study.