Death in emergency departments: a multicenter cross-sectional survey with analysis of withholding and withdrawing life support.
OBJECTIVE
To describe the characteristics of patients who die in emergency departments and the decisions to withhold or withdraw life support.


METHODS
We undertook a 4-month prospective survey in 174 emergency departments in France and Belgium to describe patients who died and the decisions to limit life-support therapies.


RESULTS
Of 2,512 patients enrolled, 92 (3.7%) were excluded prior to analysis because of missing data; 1,196 were men and 1,224 were women (mean age 77.3 +/- 15 years). Of patients, 1,970 (81.4%) had chronic underlying diseases, and 1,114 (46%) had a previous functional limitation. Principal acute presenting disorders were cardiovascular, neurological, and respiratory. Life-support therapy was initiated in 1,781 patients (73.6%). Palliative care was undertaken for 1,373 patients (56.7%). A decision to withhold or withdraw life-sustaining treatments was taken for 1,907 patients (78.8%) and mostly concerned patients over 80 years old, with underlying metastatic cancer or previous functional limitation. Decisions were discussed with family or relatives in 58.4% of cases. The decision was made by a single ED physician in 379 cases (19.9%), and by at least two ED physicians in 1,528 cases (80.1%).


CONCLUSIONS
Death occurring in emergency departments mainly concerned elderly patients with multiple chronic diseases and was frequently preceded by a decision to withdraw and/or withhold life-support therapies. Training of future ED physicians must be aimed at improving the level of care of dying patients, with particular emphasis on collegial decision-taking and institution of palliative care.
Department of Emergency Medicine, Nantes University Hospital, Nantes Cedex 01, France. philippe.leconte@chu-nantes.fr
Philippe
P
Le Conte
David
D
Riochet
Eric
E
Batard
Christelle
C
Volteau
Bruno
B
Giraudeau
Idriss
I
Arnaudet
Laetitia
L
Labastire
Jacques
J
Levraut
Frédéric
F
Thys
Dominique
D
Lauque
Claude
C
Piva
Jeannot
J
Schmidt
David
D
Trewick
Gilles
G
Potel
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D002908:Chronic Disease; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003657:Decision Making; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005602:France; D019538:Health Care Surveys; D017052:Hospital Mortality; D006801:Humans; D008020:Life Support Care / Q000706:statistics & numerical data; D008297:Male; D010166:Palliative Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D019452:Terminally Ill / Q000706:statistics & numerical data*; D028761:Withholding Treatment / Q000706:statistics & numerical data*