Limiting ICU admission from emergency services and wards
Por:
Escudero-Acha, P, Leizaola, O, Lazaro, N, Cordero, M, Cossio, A, Ballesteros, D, Recena, P, Tizon, A, Palomo, M, del Campo, M, Freita, S, Duerto, J, Bilbao, N, Vidal, B, Gonzalez-Romero, D, Diaz-Dominguez, F, Revuelto, J, Blasco, M, Domezain, M, Pavia-Pesquera, M, Ruiz, M, Pobo, A, Gomez-Acebo, I, Gonzalez-Castro, A and Grp Trabajo ADENI
Publicada:
10 dic 2021
Ahead of Print:
1 nov 2021
Categoría:
Medicine (miscellaneous)
Resumen:
Introduction: Decisions not to admit a patient to intensive care units (ICU) as a way of limiting life support treatment (LLST) is a practice that can affect the operation of the emergency services and the way in which patients die.
Methods: Post hoc analysis of the ADENI-UCI study. The main variable analysed was the reason for refusal of admission to the ICU as a measure of LLST. For the present post hoc analysis, the registered patients were divided into 2 groups: the patients assessed in the intensive medicine services from the emergency department and the patients assessed from the conventional hospitalization areas. Student t was used in the comparative statistics when the mean values of the patient sub-cohorts were compared. Categorical variables were compared with the chi(2) tests.
Results: The ADENI-ICU study included 2,284 decisions not to admit to the ICU as a measure of LLST. Estimated poor quality of life (p = .0158), the presence of severe chronic disease (P = .0169) and futility of treatment (P = .0006) were percentage decisions with greater weight within the population of hospitalized patients. The percentage of disagreement between the consulting physician and the intensivist was significantly lower in patients assessed from the emergency services (P = .0021).
Conclusions: There are appreciable differences in the reasons for consultation, as well as in those for refusal of admission to an ICU between the consultations made from an emergency department and a conventional hospitalization facility. (C) 2020 Elsevier Espana, S.L.U. All rights reserved.
Filiaciones:
Escudero-Acha, P:
Hosp Univ Marques Valdecilla, Santander, Spain
Leizaola, O:
Hosp Univ Cent Asturias, Oviedo, Spain
Lazaro, N:
Hosp 12 Octubre, Madrid, Spain
Cordero, M:
Hosp Univ Alava, Vitoria, Spain
Cossio, A:
Hosp Univ Virgen Macarena, Seville, Spain
Ballesteros, D:
Hosp Puerta Hierro, Madrid, Spain
Recena, P:
Hosp Univ Cabuenes, Gijon, Spain
Tizon, A:
Complex Hosp Univ Ourense, Orense, Spain
:
Hosp Sagunto, Valencia, Spain
del Campo, M:
Hosp Badalona Germans Trias & Pujol, Badalona, Spain
Freita, S:
Complex Hosp Univ Alvaro Cunqueiro, Vigo, Spain
Duerto, J:
Hosp Clin San Carlos, Madrid, Spain
Bilbao, N:
Hosp Galdakao Usansolo, Galdakao, Spain
:
Hosp Univ Castellon, Castellon de La Plana, Spain
Gonzalez-Romero, D:
Complejo Univ Insular Materno Infantil, Las Palmas Gran Canaria, Spain
Diaz-Dominguez, F:
Complejo Asistencial Univ Leon, Leon, Spain
Revuelto, J:
Hosp Univ Puerta Mar, Cadiz, Spain
Blasco, M:
Hosp Clin Valencia, Valencia, Spain
Domezain, M:
Hosp Univ Cruces, Bilbao, Spain
Pavia-Pesquera, M:
Hosp San Pedro, Logrono, Spain
Ruiz, M:
Hosp Jerez, Jerez de la Frontera, Spain
Pobo, A:
Hosp Joan XXIII Tarragona, Tarragona, Spain
Gomez-Acebo, I:
Univ Cantabria, Fac Med, Dept Prevent & Salud Publ, Santander, Spain
Gonzalez-Castro, A:
Hosp Univ Marques Valdecilla, Santander, Spain
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