Prevalence, goals of care and long-term outcomes of patients with life-limiting illness referred to a tertiary ICU.
OBJECTIVE
To describe the prevalence, characteristics, long-term outcomes and goals-of-care discussions of patients with objective indicators of life-limiting illnesses (LLIs) referred to the intensive care unit.


METHODS
A prospective, observational, cohort study of all adult inpatients referred to the ICU by the medical emergency team or by direct referral, during the period 30 August 2012 to 1 February 2013, at a tertiary teaching hospital in Australia.


METHODS
Mortality, LLIs, discharge destination and documentation on goals of care in medical record.


RESULTS
A total of 649 of 1024 patients referred to the ICU had an LLI, and only 34.4% of these patients had goals of care documented. Overall, 49.2% were admitted to the ICU, 48.4% were discharged home, and the 1-year mortality was 35.1%. The most common LLI criteria were heart disease (52.2%), chronic obstructive pulmonary disease (24.8%) and frailty (23.7%). The highest 1-year mortality was associated with pre-hospital residence in a nursing home (64.9%), dementia (63.3%), cancer (60.8%) and frailty (50.6%). Analysis of patients by clinical trajectory showed that 1-year mortality was significantly higher for patients with cancer (59.6%), combined organ failure and frailty (47.3%), frailty (43.8%) and organ failure (23.6%), compared with patients with no LLI (P < 0.0001).


CONCLUSIONS
A high proportion of patients referred to the ICU have an LLI, and this is associated with prolonged hospital length of stay and a high 1-year mortality, and only one-quarter have documented discussions on goals of care. Patients with cancer-related and frailty-related LLIs have the worst survival trajectories.
Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia. neilo@barwonhealth.org.au.
Neil R
NR
Orford
Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia.
Sharyn L
SL
Milnes
Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia.
Nigel
N
Lambert
Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia.
Laura
L
Berkeley
Southern GP Training, Drysdale Clinic, Geelong, VIC, Australia.
Stephen E
SE
Lane
Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia.
Nicholas
N
Simpson
Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia.
Tania
T
Elderkin
Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia.
Allison
A
Bone
Palliative Care Unit, Barwon Health, Geelong, VIC, Australia.
Peter
P
Martin
Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia.
Charlie
C
Corke
Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Rinaldo
R
Bellomo
Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Michael
M
Bailey
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D015331:Cohort Studies; D003422:Critical Care; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D015995:Prevalence; D012017:Referral and Consultation; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome