title: Compliance with triage to intensive care recommendations.
abstract: METHODS
  Recommendations for triage to intensive care units (ICUs) have been issued but not evaluated.
  
  
  METHODS
  In this prospective, multicenter study, all patients granted or refused admission to 26 ICUs affiliated with the French Society for Critical Care were included during a 1-month period. Characteristics of participating ICUs and patients, circumstances of triage, and description of the triage decision with particular attention to compliance with published recommendations were recorded.
  
  
  RESULTS
  During the study period, 1,009 patients were and 283 were not admitted to the participating ICUs. Refused patients were more likely to be older than 65 yrs (odds ratio [OR], 3.53; confidence interval [CI], 1.98-5.32) and to have a poor chronic health status (OR, 3.09; CI, 2.05-4.67). An admission diagnosis of acute respiratory or renal failure, shock, or coma was associated with admission, whereas chronic severe respiratory and heart failure or metastatic disease without hope of remission were associated with refusal (OR, 2.24; CI, 1.38-3.64). Only four (range, 0-8) of the 20 recommendations for triage to ICU were observed; a full unit and triage over the phone were associated with significantly poorer compliance with recommendations (0 [0-2] vs. 6 [2-9], p =.0003; and 1 [0-6] vs. 6 [1-9], p <.0001; respectively).
  
  
  CONCLUSIONS
  Recommendations for triage to intensive care are rarely observed, particularly when the unit is full or triage is done over the phone. These recommendations may need to be redesigned to improve their practicability under real-life conditions, with special attention to phone triage and triaging to a full unit.
authors.affiliation: Intensive Care and Biostatistics Departments, Saint-Louis Teaching Hospital and Paris VII Teaching, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Azoulay
authors.forename: F
authors.initials: F
authors.lastname: Pochard
authors.forename: S
authors.initials: S
authors.lastname: Chevret
authors.forename: C
authors.initials: C
authors.lastname: Vinsonneau
authors.forename: M
authors.initials: M
authors.lastname: Garrouste
authors.forename: Y
authors.initials: Y
authors.lastname: Cohen
authors.forename: M
authors.initials: M
authors.lastname: Thuong
authors.forename: C
authors.initials: C
authors.lastname: Paugam
authors.forename: C
authors.initials: C
authors.lastname: Apperre
authors.forename: B
authors.initials: B
authors.lastname: De Cagny
authors.forename: F
authors.initials: F
authors.lastname: Brun
authors.forename: C
authors.initials: C
authors.lastname: Bornstain
authors.forename: A
authors.initials: A
authors.lastname: Parrot
authors.forename: F
authors.initials: F
authors.lastname: Thamion
authors.forename: J C
authors.initials: JC
authors.lastname: Lacherade
authors.forename: Y
authors.initials: Y
authors.lastname: Bouffard
authors.forename: J R
authors.initials: JR
authors.lastname: Le Gall
authors.forename: C
authors.initials: C
authors.lastname: Herve
authors.forename: M
authors.initials: M
authors.lastname: Grassin
authors.forename: R
authors.initials: R
authors.lastname: Zittoun
authors.forename: B
authors.initials: B
authors.lastname: Schlemmer
authors.forename: J F
authors.initials: JF
authors.lastname: Dhainaut
mesh_terms: D000367:Age Factors; D000368:Aged; D001291:Attitude of Health Personnel; D005260:Female; D005602:France; D019983:Guideline Adherence; D006304:Health Status; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011379:Prognosis; D011788:Quality of Life; D014218:Triage / Q000379:methods*