title: Triaging patients to the ICU: a pilot study of factors influencing admission decisions and patient outcomes.
abstract: OBJECTIVE
  To assess the appropriateness of ICU triage decisions. DESIGN. Prospective descriptive single-center study.
  
  
  METHODS
  Ten-bed, medical-surgical ICU in an acute-care 460-bed, tertiary care hospital.
  
  
  METHODS
  All patients triaged for admission were entered prospectively.
  
  
  METHODS
  None.
  
  
  RESULTS
  Age, underlying diseases, admission diagnoses, Mortality Probability Model (MPM0) score, information available to ICU physicians, and mortality were recorded. Of the 334 patients (96% medical), 145 (46.4%) were refused. Reasons for refusal were being too-sick-to-benefit (48, 14%) and too-well-to-benefit (93, 28%). Factors independently associated with refusal were patient location, ICU physician seniority, bed availability, patient age, underlying diseases, and disability. Hospital mortality was 23% and 27% for patients admitted to our ICU and other ICUs, respectively, and 7.5% and 60% for patients too well and too sick to benefit, respectively. In the multivariate Cox model, McCabe = 1 [hazard ratio (HR), 0.44 (95% CI, 0.24-0.77), P=0.001], living at home without help (HR, 0.440, 95% CI, 0.28-0.68, P=0.0003), and immunosuppression (HR, 1.91, 95% CI, 1.09-3.33, P=0.02) were independent predictors of hospital death. Neither later ICU admission nor refusal was associated with cohort survival. MPM0 was not associated with hospital mortality.
  
  
  CONCLUSIONS
  Refusal of ICU admission was related to the ability of the triaging physician to examine the patient, ICU physician seniority, patient age, underlying diseases, self-sufficiency, and number of beds available. Specific training of junior physicians in triaging might bring further improvements. Scores that are more accurate than the MPM0 are needed.
authors.affiliation: Medical-Surgical ICU, Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France. mgarrouste@hopital-saint-joseph.org
authors.forename: Maité
authors.initials: M
authors.lastname: Garrouste-Orgeas
authors.forename: Luc
authors.initials: L
authors.lastname: Montuclard
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
authors.forename: Benoit
authors.initials: B
authors.lastname: Misset
authors.forename: Marie
authors.initials: M
authors.lastname: Christias
authors.forename: Jean
authors.initials: J
authors.lastname: Carlet
mesh_terms: D003657:Decision Making; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D010865:Pilot Projects; D011336:Probability; D014218:Triage