Long-Term Outcomes After ICU Admission Triage in Octogenarians.
OBJECTIVE
To describe ICU admission triage and outcomes in octogenarians.


METHODS
Multicenter prospective observational study.


METHODS
Three nonuniversity hospitals and three university hospitals in Norway.


METHODS
Patients 80 years old or older who were referred for ICU admission from November 2013 to October 2014.


METHODS
None.


RESULTS
Of the 355 included patients, 105 (29.6%) were refused ICU treatment. Risk factors for ICU refusal in patients considered "too ill/old" were advanced age and low functional status. Risk factors for ICU refusal in patients considered "too well" were advanced age, male sex, university hospital admission, comorbidity, and low Simplified Acute Physiology Score 3. Overall ICU survival was 71.6%. Hospital and 1-year survival were 56.0% and 40.0% in the ICU-admitted, 65.2% and 50.0% in the nonadmitted patients considered too well, and 32.7% and 11.5% in patients considered too ill/old, respectively. The adjusted Kaplan-Meier curves showed significantly lower survival for nonadmitted patients considered too ill/old than for ICU-admitted patients and nonadmitted patients considered too well. At follow-up, triage patients had lower health-related quality of life than an age- and sex-matched control group in the domains of self-care, usual care, and anxiety and depression, and a lower EuroQol visual analog scale scores.


CONCLUSIONS
Overall, 29.6% of the patients were refused ICU treatment. The adjusted survival analyses showed a significantly higher survival for ICU-admitted octogenarians than for nonadmitted patients who were considered too ill/old, indicating a benefit of ICU admission. Overall, the follow-up of triage patients showed lower health-related quality of life than an age- and sex-matched control population.
1Department of Anesthesia and Intensive Care, Møre and Romsdal Health Trust, Ålesund Hospital, Ålesund, Norway.2Department of Circulation and Medical Imaging, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.3Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.4Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.5Department of Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.6Department of Public Health and General Practice, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.7Department of Anesthesia and Intensive Care, Stavanger University Hospital, Stavanger, Norway.8Department of Anesthesia and Intensive Care, Fonna Health Trust, Haugesund Hospital, Haugesund, Norway.9Department of Anesthesia and Intensive Care, Østfold Hospital, Fredrikstad, Norway.
Finn H
FH
Andersen
Hans
H
Flaatten
Pål
P
Klepstad
Turid
T
Follestad
Kristian
K
Strand
Andreas J
AJ
Krüger
Michael
M
Hahn
Christian
C
Buskop
Anne-Karin
AK
Rime
Reidar
R
Kvåle
D000367:Age Factors; D000369:Aged, 80 and over; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D008297:Male; D009664:Norway; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D011446:Prospective Studies; D011788:Quality of Life; D016079:Refusal to Treat; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D014218:Triage