title: The probability of having advanced medical interventions is associated with age in out-of-hospital life-threatening situations.
abstract: BACKGROUND
  The use of out-of-hospital emergency medical services by old and very old individuals is increasing. These patients frequently require complex evaluation and decision-making processes to determine a strategy of care, therapeutic choices or withdrawal of care in life-threatening situations. During out-of-hospital missions, thorough decision-making is difficult because of the limited amount of time and lack of direct access to medical charts or to pre-existing advance directives. In this setting, age may be used as a proxy to determine strategy of care, therapeutic choices or withdrawal of care, particularly in relation to advanced medical interventions. We aimed to determine how an emergency physician's initiation of out-of-hospital advanced medical interventions varies with the patient's age.
  
  
  METHODS
  We performed a retrospective analysis of the missions conducted by the emergency physicians-staffed emergency medical services in a Swiss region. We used logistic regression analysis to determine whether the probability of receiving an advanced medical intervention was associated with the patient's age.
  
  
  RESULTS
  Among 21,922 out-of-hospital emergency adult missions requiring an emergency physician, the probability of receiving an advanced medical intervention decreased with age. It was highest among those aged 18 - 58 years and significantly lower among those aged ≥ 89 years (OR = 0.66; 95 % CI: 0.53 - 0.82). The probability of cardiopulmonary resuscitation attempts progressively decreased with age and was significantly lower for the three oldest age deciles (80 - 83, 84 - 88 and ≥ 89 years).
  
  
  CONCLUSIONS
  The number of out-of-hospital advanced medical interventions significantly decreased for patients aged ≥ 89 years. It is unknown whether this lower rate of interventions was related only to age or to other medical characteristics of these patients, such as the number or severity of comorbidities. Thus, further studies are needed to confirm whether this observation corresponds to underuse of advanced medical interventions in very old patients.
authors.affiliation: Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Vania
authors.initials: V
authors.lastname: Tavares
authors.affiliation: Emergency Department, Lausanne University Hospital, CH-1011, Lausanne, Switzerland. pierre-nicolas.carron@chuv.ch.
authors.forename: Pierre-Nicolas
authors.initials: PN
authors.lastname: Carron
authors.affiliation: Emergency Department, Lausanne University Hospital, CH-1011, Lausanne, Switzerland.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Yersin
authors.affiliation: Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Taffé
authors.affiliation: Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Bernard
authors.initials: B
authors.lastname: Burnand
authors.affiliation: Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Valérie
authors.initials: V
authors.lastname: Pittet
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000379:methods*; D016208:Databases, Factual; D003657:Decision Making; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013557:Switzerland; D055815:Young Adult
keywords: Ageing; Cardiopulmonary resuscitation; Critical care medicine; Decision-making; Out-of-hospital emergency medical services