title: Triage practices in stroke units: Physicians' perceptions and ethical issues.
abstract: OBJECTIVE
  We aimed to explore acute stroke admission decisions and to discuss ethical issues in triage practices in stroke units (SUs) in France.
  
  
  METHODS
  In this study, 337 questionnaires were sent to physicians involved in acute admission to SUs in Île-de-France (neurologists and physicians from emergency medical services). The questionnaires comprised questions about physicians' perceptions of the reasonable allocation of SU beds and admission criteria for patients in SU in clinical vignettes illustrating complex situations.
  
  
  RESULTS
  In total, 162 questionnaires were fully completed. There were some discrepancies in perceptions and reporting practices between emergency physicians and neurologists concerning patient admission criteria. Triage choices were more frequently declared by emergency physicians than by neurologists and were related to the difficulty of obtaining a positive response for the admission of certain complex patients (particularly those with comorbidities).
  
  
  CONCLUSIONS
  Despite recommendations stating that all patients with stroke should be admitted to SUs, this study has shown that triage practices exist in stroke admission decisions. The triage depends on the role and perceptions of each physician in acute stroke management. These decisions suggest reflections on the applicability of distributive justice theories and on ethical issues in triage practices in medicine.
authors.affiliation: Service de neurologie, hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France. Electronic address: marion.yger@aphp.fr.
authors.forename: M
authors.initials: M
authors.lastname: Yger
authors.affiliation: Urgences cérébrovasculaires, groupe hospitalier Pité-Salpêtrière, Assistance publique-Hôpitaux de Paris (AP-HP), 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Crozier
authors.affiliation: Brigade des sapeurs-pompiers de Paris, caserne de Port-Royal, 75013 Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Dubourdieu
authors.affiliation: SAMU de Paris, hôpital Necker-Enfants-Malades, université Paris Descartes - Paris V, AP-HP, 75730 Paris cedex 15, France.
authors.forename: B
authors.initials: B
authors.lastname: Vivien
authors.affiliation: GCS DSISIF, 75009 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Dolveck
authors.affiliation: Urgences cérébrovasculaires, groupe hospitalier Pité-Salpêtrière, Assistance publique-Hôpitaux de Paris (AP-HP), 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Samson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D004632:Emergency Medical Services / Q000941:ethics; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009462:Neurology / Q000941:ethics; D010343:Patient Admission / Q000592:standards; D010465:Perception / Q000941:ethics*; D010820:Physicians / Q000941:ethics / Q000523:psychology; D010818:Practice Patterns, Physicians' / Q000941:ethics* / Q000592:standards / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014218:Triage / Q000941:ethics* / Q000379:methods*; D000078329:Workforce
keywords: Accident vasculaire cérébral; Décision médicale; Ethics; Medical decision; Stroke; Triage; Éthique