Death in emergency departments: a multicenter cross-sectional survey with analysis of withholding and withdrawing life support
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To describe the characteristics of patients who die in emergency departments and the decisions to withhold or withdraw life support.
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.
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%).
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.
- Death in emergency departments: a multicenter cross-sectional survey with analysis of withholding and withdrawing life support
Intensive Care Medicine
Volume 36, Issue 5 , pp 765-772
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- Emergency medicine
- End of life
- Palliative care
- Industry Sectors
- Author Affiliations
- 1. Department of Emergency Medicine, Nantes University Hospital, 44093, Nantes Cedex 01, France
- 2. Biostatistic Department, Nantes University Hospital, Nantes, France
- 3. INSERM CIC 202, CHRU de Tours, Université François Rabelais Tours, Tours, France
- 4. Department of Emergency Medicine, Nice University Hospital, Nice, France
- 5. Emergency Department, Clinique Universitaire Saint Luc, Brussels, Belgium
- 6. Department of Emergency Medicine, Toulouse University Hospital, Toulouse, France
- 7. Department of Emergency Medicine, Limoges University Hospital, Limoges, France
- 8. Department of Emergency Medicine, Clermont Ferrand University Hospital, Clermont, France