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

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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.

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Notes

  1. Knaus’s class A: prior good health with no functional limitations; class B: mild to moderate limitation in activity because of chronic health problem; class C: chronic disease producing serious but not incapacitating restriction of activity; class D: severe restriction of activity due to disease, including bedridden.

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Acknowledgments

This study was financed by a grant from the French Programme Hospitalier de Recherche Clinique.

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, Nantes University Hospital, 44093, Nantes Cedex 01, France

    Philippe Le Conte, David Riochet, Eric Batard, Idriss Arnaudet, Laetitia Labastire, David Trewick & Gilles Potel

  2. Biostatistic Department, Nantes University Hospital, Nantes, France

    Christelle Volteau

  3. INSERM CIC 202, CHRU de Tours, Université François Rabelais Tours, Tours, France

    Bruno Giraudeau

  4. Department of Emergency Medicine, Nice University Hospital, Nice, France

    Jacques Levraut

  5. Emergency Department, Clinique Universitaire Saint Luc, Brussels, Belgium

    Frédéric Thys

  6. Department of Emergency Medicine, Toulouse University Hospital, Toulouse, France

    Dominique Lauque

  7. Department of Emergency Medicine, Limoges University Hospital, Limoges, France

    Claude Piva

  8. Department of Emergency Medicine, Clermont Ferrand University Hospital, Clermont, France

    Jeannot Schmidt

Authors
  1. Philippe Le Conte
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  2. David Riochet
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  3. Eric Batard
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  4. Christelle Volteau
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  7. Laetitia Labastire
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  8. Jacques Levraut
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  10. Dominique Lauque
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  12. Jeannot Schmidt
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  13. David Trewick
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  14. Gilles Potel
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Corresponding author

Correspondence to Philippe Le Conte.

Additional information

This article is discussed in the editorial available at: doi:10.1007/s00134-010-1803-y.

Investigators

Investigators

Le Conte Philippe, Nantes, Levraut Jacques, Nice, Dahmani Noura, Bordeaux, Lemarchand Philippe, Rouen, Baboni Samuel, Toulouse, Rebahi Sofiane, Limoges, Schmidt Jeannot, Clermond Ferrand, Delbarre Cécile, Vannes, Colombani Philippe, Lyon, Héricord Philippe, Hôpital Saint Antoine, RAfidiniaina Diana, Lyon, Proust Philippe, Béthune, Carpentier Françoise, Grenobles, Benchouieb Salim, Saint Etienne, Delhumeau Alain, Angers, Petrissans Bernard, Clamart, Choukroanun Jacques, Le Mans, Alazia Marc, Marseilles, Ferrer Richard, Valenciennes, Casalino Enrique, Le Kremlin Bicètre, Capelleir Gilles, Besançon, Berranger Christophe, Saint Nazaire, Rouffineau Jean, Poitiers, Capelle Philippe, Maubeuge, Honnart Didier, Dijon, Bouget Jacques, Rennes, Pédrant Gérard, Toulon, Brest, Lauque Dominique, Toulouse, Bleichner Gérard, Argenteuil, Lestavel Philippe, Henin Beaumont, Meyrant Sylvie, Lyon, Viudes Gilles, Toulon, Philippe Olivier, Avignon, Bazin Arnaud, Reims, Coche Regis, Douais, Simonetti Maurice, Point à Pitre, Rocher Eric, Quimper, Cordier Bruno, Hôpital Saint Joseph, Jordy Christophe, Versailles, Martin Patrick Orleans, Valet Daniel, Beauvais, Louis Fabrice, Grasse, Kiegel Pierre, Aix en Provence, Santias Carlos, Saint Lô, Merit Jean Bernard, La Roche sur Yon, Reynart Marc, Bruxelles, Renaud Bertrand, Créteil, Duriez Frédéric, Chartres, Sablé Yann, Saint Malo, Driencourt Jean Batiste, Annecy, Thomas Laurent, Fort de France, Hugerot Alain, Troyes, Mounios Francis, La Rochelle, Chanseau Pierre, Libourne, Cannamela Alain, Roanne, Poujol Bruno, Cholet, Mardegan Pierre, Montauban, Rothe Marie-Rose, Saint Brieuc, Vinciguerra Daniel, Toulon, Le Roux Catherine, Caen, Bec Jean François, Vienne, Meyer Gérard, Creil, Maury Alain, Chambery, Bray Marc, Evry, Brun Patrick, Colombes, Morbidelli Philippe, Saint Paul, Pelgrim Jean Pierre, Bruxelles, Benoit Marie-Agnes, Monromantin, Rottner Jean, Mulhouse, Plaisance Patrick, Paris, Pédrant Gérard, Toulon, Rouvier René, Saint Raphael, Coquenpot Frédéric, Sens, Schweig Thierry, Chinon, Ellissef Thierry, Lons, Bonfils Caroline, Lille, Jaeger Albert, Strasbourg, Werner Patrick, Paris, Lebrin Patrick, Bry sur Marne, Benatia Pierre, Montpellier, Chenu Yvonnick, Dax, Hernandez Stephane, Chateaubriant, Alexandre Jean Louis, Chalon en Champagne, Chabot Laurent, Laval, Steffann Jean, Gray, Tavernier Danielle, Thonon les Bains, Brousse Benoit, Elbeuf, Dumas Thierry, Gueret, Lebrun Philippe, Evreux, Jeleff Charles, Compiègne, Dhainaut Jean François, Paris, Briquet Patricia, Le Havre, Niemitz Bernard, Amiens, Rambo Olivier, Challans, Camelbeek Patrick, Montegnée, Voisin Xavier, Antibes, Chanseau Pierre, Sainte Foix La Grande, Braun François, Verdun, Ballestrazzi Véronique, Armentière, Kopferschmitt Jacques, Strasbourg, Taboulet Pierre, Paris, Raphael Maurice, Montfermeil, Pecot Fabrice, Villepinte, Camard Charles Noël, Moulins, Brunet Jean Marie, Dreux, Lanotte Régis, Tours, Pone Jean Marc, Etampes, Mathieu Emmanuel, Suresnes, Bernard Marc, Guise, Hidoux-Lafarge Marie-Annick, Gap, Hamon Michel, Martigues, Maillard Laurent, Agen, Mariotti Jean Christophe, Cherbourg, Noizet Marc, Epernay, Sattonet Philippe, Thionville, Pourriat Jean Louis, Paris, Rahmani Jamil, Paris, Bal Jean Pierre, Créteil, Duval Gilbert, Pontoise, Fontanella Jean Michel, Cayenne, Fox Albert, Namur, Bedock Bernard, Annonay, Lindenmeyer Eric, Marseilles, Sorin Gilles, Chateaudun, Lavergne Guillaume, Arcachon, Dumont Odile, Voiron, Niziolek Christian, Aussedat Michel, Metz, Bray Marc, Corbeil, Samuel Serge, Le Lamantin, Bourde Arnaud, Saint Denis de la Réunion, Le Moine Patrick, Landerneau, Kosayyer Mouaffak, Sarreguemine, Ong Seng Joseph, L’Aigle, Jourdan-Duigou Brigitte, Sable sur Sarthe, Marchand Didier, Fougères, Payre Jean Hugues, Saint Chamon, Lepoutre Bernadette, Lomme, Rammal Fadi, Noyon, Malogne Hervé, Calais, Fadel Nicolas, Rambouillet, Kfoury Michel, Abbeville, Tanguy Loïc, Millau, Le Bras Daniel, Quimperlé, de Chabalier Bertrand, Saint Gaudens, Frocrain Eric, Ancenis, Gaspari Thierry, Granville, Soilen Isabelle, Senlis, Charpentier Eric, Clermont de l’Oise, Haegy Jean Marie, Colmar, Roy Patricia, Provins, Grippon Philippe, Fontainebleau, Villate Dominique, Saint Junien, Frigui Lotfi, Joigny, Phlippoteau-Paris Catherine, Montreuil, Mattei Véronique, Menton, Moretto Céline, Romilly sur Seine, Philippe Jean Marc, Aurillac, Gaudin Bénédicte, Vernon, Tsabet Ahmed, Figeac, Goulmy Michel, Bar le Duc, Fichaux Yves, Seclin, Couton Philippe, Mortagne au Perche, Reinsberger Hervé, Orthez, Ménard Pierre, Gisors, Lae Claude, Annemasse, Charlier Franck, Lillebonne, Coudert Benoit, Meulan, Cantegril Annette, Lavaur, Rivoal Michel, Arpajon, Jacques Eric, Beaumont sur Oise, Lepori Michel, Soissons, Khalaf Lutfi, Hirson, Jaffier Claude, Istres.

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Le Conte, P., Riochet, D., Batard, E. et al. Death in emergency departments: a multicenter cross-sectional survey with analysis of withholding and withdrawing life support. Intensive Care Med 36, 765–772 (2010). https://doi.org/10.1007/s00134-010-1800-1

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  • DOI: https://doi.org/10.1007/s00134-010-1800-1

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