Original

Intensive Care Medicine

, Volume 36, Issue 5, pp 765-772

Death in emergency departments: a multicenter cross-sectional survey with analysis of withholding and withdrawing life support

  • Philippe Le ConteAffiliated withDepartment of Emergency Medicine, Nantes University Hospital Email author 
  • , David RiochetAffiliated withDepartment of Emergency Medicine, Nantes University Hospital
  • , Eric BatardAffiliated withDepartment of Emergency Medicine, Nantes University Hospital
  • , Christelle VolteauAffiliated withBiostatistic Department, Nantes University Hospital
  • , Bruno GiraudeauAffiliated withINSERM CIC 202, CHRU de Tours, Université François Rabelais Tours
  • , Idriss ArnaudetAffiliated withDepartment of Emergency Medicine, Nantes University Hospital
  • , Laetitia LabastireAffiliated withDepartment of Emergency Medicine, Nantes University Hospital
  • , Jacques LevrautAffiliated withDepartment of Emergency Medicine, Nice University Hospital
  • , Frédéric ThysAffiliated withEmergency Department, Clinique Universitaire Saint Luc
    • , Dominique LauqueAffiliated withDepartment of Emergency Medicine, Toulouse University Hospital
    • , Claude PivaAffiliated withDepartment of Emergency Medicine, Limoges University Hospital
    • , Jeannot SchmidtAffiliated withDepartment of Emergency Medicine, Clermont Ferrand University Hospital
    • , David TrewickAffiliated withDepartment of Emergency Medicine, Nantes University Hospital
    • , Gilles PotelAffiliated withDepartment of Emergency Medicine, Nantes University Hospital

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Abstract

Purpose

To describe the characteristics of patients who die in emergency departments and the decisions to withhold or withdraw life support.

Methods

We undertook a 4-month prospective survey in 174 emergency departments in France and Belgium to describe patients who died and the decisions to limit life-support therapies.

Results

Of 2,512 patients enrolled, 92 (3.7%) were excluded prior to analysis because of missing data; 1,196 were men and 1,224 were women (mean age 77.3 ± 15 years). Of patients, 1,970 (81.4%) had chronic underlying diseases, and 1,114 (46%) had a previous functional limitation. Principal acute presenting disorders were cardiovascular, neurological, and respiratory. Life-support therapy was initiated in 1,781 patients (73.6%). Palliative care was undertaken for 1,373 patients (56.7%). A decision to withhold or withdraw life-sustaining treatments was taken for 1,907 patients (78.8%) and mostly concerned patients over 80 years old, with underlying metastatic cancer or previous functional limitation. Decisions were discussed with family or relatives in 58.4% of cases. The decision was made by a single ED physician in 379 cases (19.9%), and by at least two ED physicians in 1,528 cases (80.1%).

Conclusions

Death occurring in emergency departments mainly concerned elderly patients with multiple chronic diseases and was frequently preceded by a decision to withdraw and/or withhold life-support therapies. Training of future ED physicians must be aimed at improving the level of care of dying patients, with particular emphasis on collegial decision-taking and institution of palliative care.

Keywords

Death Emergency medicine Ethic End of life Palliative care