title: Variability of intensive care admission decisions for the very elderly.
abstract: Although increasing numbers of very elderly patients are requiring intensive care, few large sample studies have investigated ICU admission of very elderly patients. Data on pre triage by physicians from other specialities is limited. This observational cohort study aims at examining inter-hospital variability of ICU admission rates and its association with patients' outcomes. All patients over 80 years possibly qualifying for ICU admission who presented to the emergency departments (ED) of 15 hospitals in the Paris (France) area during a one-year period were prospectively included in the study. Main outcome measures were ICU eligibility, as assessed by the ED and ICU physicians; in-hospital mortality; and vital and functional status 6 months after the ED visit. 2646 patients (median age 86; interquartile range 83-91) were included in the study. 94% of participants completed follow-up (n = 2495). 12.4% (n = 329) of participants were deemed eligible for ICU admission by ED physicians and intensivists. The overall in-hospital and 6-month mortality rates were respectively 27.2% (n = 717) and 50.7% (n = 1264). At six months, 57.5% (n = 1433) of patients had died or had a functional deterioration. Rates of patients deemed eligible for ICU admission ranged from 5.6% to 38.8% across the participating centers, and this variability persisted after adjustment for patients' characteristics. Despite this variability, we found no association between level of ICU eligibility and either in-hospital death or six-month death or functional deterioration. In France, the likelihood that a very elderly person will be admitted to an ICU varies widely from one hospital to another. Influence of intensive care admission on patients' outcome remains unclear.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00912600.
authors.affiliation: Unité de Recherche en Épidémiologie Systèmes d'Information et Modélisation U707, Institut national de la santé et de la recherche médicale, Paris, France. ariane.boumendil@gmail.com
authors.forename: Ariane
authors.initials: A
authors.lastname: Boumendil
authors.forename: Derek C
authors.initials: DC
authors.lastname: Angus
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Guitonneau
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Menn
authors.forename: Christine
authors.initials: C
authors.lastname: Ginsburg
authors.forename: Khalil
authors.initials: K
authors.lastname: Takun
authors.forename: Alain
authors.initials: A
authors.lastname: Davido
authors.forename: Rafik
authors.initials: R
authors.lastname: Masmoudi
authors.forename: Benoît
authors.initials: B
authors.lastname: Doumenc
authors.forename: Dominique
authors.initials: D
authors.lastname: Pateron
authors.forename: Maité
authors.initials: M
authors.lastname: Garrouste-Orgeas
authors.forename: Dominique
authors.initials: D
authors.lastname: Somme
authors.forename: Tabassome
authors.initials: T
authors.lastname: Simon
authors.forename: Philippe
authors.initials: P
authors.lastname: Aegerter
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guidet
mesh_terms: D000369:Aged, 80 and over; D003657:Decision Making; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data*; D014218:Triage / Q000706:statistics & numerical data