Selection of intensive care unit admission criteria for patients aged   80 years and over and compliance of emergency and intensive care   unit physicians with the selected criteria: An observational,   multicenter, prospective study.
OBJECTIVE
To describe intensive care unit referral decisions by emergency room physicians in patients aged > or =80 yrs.


METHODS
Prospective, observational cohort study of patients aged > or =80 yrs who were triaged in the emergency room, using a list of intensive care unit admission criteria selected by emergency physicians among 76 preliminary criteria adapted from the 1999 Society of Critical Care Medicine guidelines. The Delphi method was used to select the criteria.


METHODS
Fifteen French hospitals.


METHODS
A total of 2646 patients aged > or =80 yrs with at least one criterion.


METHODS
None.


RESULTS
In the Delphi process, level of agreement was assessed as follows: when all answers fell within a single interval (7-9 = definite admission criteria; 4-6 = equivocal admission criteria or 1-3 = inappropriate admission), agreement was strong; when answers spanned two intervals, agreement was fair; and when answers spanned all three intervals, agreement was poor. Of the 76 preliminary criteria, two were removed; 44 were selected as definite intensive care unit admission criteria; and 30 were selected as equivocal intensive care unit admission criteria. Of the 1426 patients meeting definite admission criteria, 441 (30.9%) were referred for intensive care unit admission and 231 of 441 (52.4%) were admitted to the intensive care unit. Of the 1041 patients with equivocal admission criteria, 181 (17.3%) were referred for intensive care unit admission; and, of these, 79 (43.6%) were admitted to the intensive care unit. Factors associated independently with no intensive care unit referral were age odds ratio [OR], 1.04; 95% confidence interval [CI], 1.04-1.07), active cancer (OR, 1.61; 95% CI, 1.09-1.38), unknown hospitalization status (OR, 1.53; 95% CI, 1.11-2.11), unknown living arrangements (OR, 1.69; 95% CI, 1.19-2.42), regular psychotropic medications (OR, 1.42; 95% CI, 1.10-1.81), low severity at referral (OR, 0.60; 95% CI, 0.53-0.68), low activity in daily living score (OR, 0.93; 95% CI, 0.88-0.99).


CONCLUSIONS
Emergency and intensive care unit physicians were extremely reluctant to consider intensive care unit admission of patients aged > or =80 yrs, despite the presence of criteria indicating that intensive care unit admission was certainly or possibly appropriate.
Saint Joseph Hospital Network, Medical-Chirurgical ICU, Paris, France. mgarrouste@hpsj.fr
Maité
M
Garrouste-Orgeas
Ariane
A
Boumendil
Dominique
D
Pateron
Philippe
P
Aergerter
Dominique
D
Somme
Tabassome
T
Simon
Bertrand
B
Guidet
D000203:Activities of Daily Living; D000369:Aged, 80 and over; D003697:Delphi Technique; D004185:Disability Evaluation; D004636:Emergency Service, Hospital; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D009369:Neoplasms / Q000453:epidemiology; D010343:Patient Admission / Q000592:standards* / Q000706:statistics & numerical data; D018579:Patient Selection; D011446:Prospective Studies; D011619:Psychotropic Drugs / Q000627:therapeutic use; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012111:Residence Characteristics; D012720:Severity of Illness Index
D011619:Psychotropic Drugs