title: The Eldicus prospective, observational study of triage decision making in European intensive care units. Part II: intensive care benefit for the elderly.
abstract: BACKGROUND
  Life and death triage decisions are made daily by intensive care unit physicians. Admission to an intensive care unit is denied when intensive care unit resources are constrained, especially for the elderly.
  
  
  OBJECTIVE
  To determine the effect of intensive care unit triage decisions on mortality and intensive care unit benefit, specifically for elderly patients.
  
  
  METHODS
  Prospective, observational study of triage decisions from September 2003 until March 2005.
  
  
  METHODS
  Eleven intensive care units in seven European countries.
  
  
  METHODS
  All patients >18 yrs with an explicit request for intensive care unit admission.
  
  
  METHODS
  Admission or rejection to intensive care unit.
  
  
  RESULTS
  Demographic, clinical, hospital, physiologic variables, and 28-day mortality were obtained on consecutive patients. There were 8,472 triages in 6,796 patients, 5,602 (82%) were accepted to the intensive care unit, 1,194 (18%) rejected; 3,795 (49%) were ≥ 65 yrs. Refusal rate increased with increasing patient age (18-44: 11%; 45-64: 15%; 65-74: 18%; 75-84: 23%; >84: 36%). Mortality was higher for older patients (18-44: 11%; 45-64: 21%; 65-74: 29%; 75-84: 37%; >84: 48%). Differences between mortalities of accepted vs. rejected patients, however, were greatest for older patients (18-44: 10.2% vs. 12.5%; 45-64: 21.2% vs. 22.3%; 65-74: 27.9% vs. 34.6%; 75-84: 35.5% vs. 40.4%; >84: 41.5% vs. 58.5%). Logistic regression showed a greater mortality reduction for accepted vs. rejected patients corrected for disease severity for elderly patients (age >65 [odds ratio 0.65, 95% confidence interval 0.55-0.78, p < .0001]) than younger patients (age <65 [odds ratio 0.74, 95% confidence interval 0.57-0.97, p = .01]).
  
  
  CONCLUSIONS
  Despite the fact that elderly patients have more intensive care unit rejections than younger patients and have a higher mortality when admitted, the mortality benefit appears greater for the elderly. Physicians should consider changing their intensive care unit triage practices for the elderly.
authors: Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel. charles.sprung@ekmd.huji.ac.il
authors: Charles L
authors: CL
authors: Sprung
authors: Antonio
authors: A
authors: Artigas
authors: Jozef
authors: J
authors: Kesecioglu
authors: Angelo
authors: A
authors: Pezzi
authors: Joergen
authors: J
authors: Wiis
authors: Romain
authors: R
authors: Pirracchio
authors: Mario
authors: M
authors: Baras
authors: David L
authors: DL
authors: Edbrooke
authors: Antonio
authors: A
authors: Pesenti
authors: Jan
authors: J
authors: Bakker
authors: Chris
authors: C
authors: Hargreaves
authors: Gabriel
authors: G
authors: Gurman
authors: Simon L
authors: SL
authors: Cohen
authors: Anne
authors: A
authors: Lippert
authors: Didier
authors: D
authors: Payen
authors: Davide
authors: D
authors: Corbella
authors: Gaetano
authors: G
authors: Iapichino
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003661:Decision Support Techniques; D005060:Europe; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000592:standards; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D014218:Triage / Q000592:standards; D055815:Young Adult