title: Withholding and withdrawing life-support therapy in an Emergency Department: prospective survey.
abstract: OBJECTIVE
  Few studies have focused on decisions to withdraw or withhold life-support therapies in the emergency department. Our objectives were to identify clinical situations where life-support was withheld or withdrawn, the criteria used by physicians to justify their decisions, the modalities necessary to implement these decisions, patient disposition, and outcome.
  
  
  METHODS
  Prospective unicenter survey in an Emergency Department of a tertiary care teaching hospital.
  
  
  METHODS
  All non-trauma patients (n=119) for whom a decision to withhold or withdraw life-sustaining treatments was taken between January and September 1998.
  
  
  METHODS
  Choice of criteria justifying the decision to withhold or withdraw life-sustaining treatments, time interval from ED admission to the decision; type of decision implemented, outcome.
  
  
  RESULTS
  Fourteen thousand eight hundred and seventy-five non-trauma patients were admitted during the study period, 119 were included, mean age 75+/-13 years. Resuscitation procedures were instituted for 96 (80%) patients before a subsequent decision was taken. Physicians chose on average 6+/-2 items to justify their decision; the principal acute medical disorder and futility of care were the two criteria most often used. Median time interval to reach the decision was 187 min. Withdrawal involved 37% of patients and withholding 63% of patients. The family was involved in the decision-making process in 72% of patients. The median time interval from the decision to death was 16 h (5 min to 140 days).
  
  
  CONCLUSIONS
  Withdrawing and withholding life-support therapy involved elderly patients with underlying chronic cardiopulmonary disease or metastatic cancer or patients with acute non-treatable illness.
authors.affiliation: Service d'Accueil et d'Urgences, Centre Hospitalier Universitaire, 44093 Nantes, France. philippe.leconte@chu-nantes.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Le Conte
authors.forename: Denis
authors.initials: D
authors.lastname: Baron
authors.forename: David
authors.initials: D
authors.lastname: Trewick
authors.forename: Marie Dominique
authors.initials: MD
authors.lastname: Touzé
authors.forename: Céline
authors.initials: C
authors.lastname: Longo
authors.forename: Irshaad
authors.initials: I
authors.lastname: Vial
authors.forename: Danielle
authors.initials: D
authors.lastname: Yatim
authors.forename: Gille
authors.initials: G
authors.lastname: Potel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D004636:Emergency Service, Hospital; D005260:Female; D006304:Health Status; D006801:Humans; D008020:Life Support Care / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012151:Resuscitation; D028761:Withholding Treatment