Original

Intensive Care Medicine

, Volume 38, Issue 7, pp 1169-1176

Increased nonbeneficial care in patients spending their birthday in the ICU

  • Elie AzoulayAffiliated withMedical ICU, AP-HP, Hôpital Saint-LouisUFR de Médecine, University Paris-7 Paris-Diderot Email author 
  • , Maité GarrousteAffiliated withMedical ICU, AP-HP, Hôpital Saint-Louis
  • , Dany Goldgran-ToledanoAffiliated withMedical ICU, AP-HP, Hôpital Saint-Louis
  • , Christophe AdrieAffiliated withMedical ICU, AP-HP, Hôpital Saint-Louis
  • , Adeline MaxAffiliated withMedical ICU, AP-HP, Hôpital Saint-Louis
  • , Aurélien VesinAffiliated withMedical ICU, AP-HP, Hôpital Saint-Louis
  • , Adrien FrancaisAffiliated withMedical ICU, AP-HP, Hôpital Saint-Louis
  • , Jean-Ralph ZaharAffiliated withMedical ICU, AP-HP, Hôpital Saint-Louis
  • , Yves CohenAffiliated withMedical ICU, AP-HP, Hôpital Saint-Louis
    • , Bernard AllaouchicheAffiliated withMedical ICU, AP-HP, Hôpital Saint-Louis
    • , Benoît SchlemmerAffiliated withMedical ICU, AP-HP, Hôpital Saint-Louis
    • , Jean-François TimsitAffiliated withMedical ICU, AP-HP, Hôpital Saint-Louis

Abstract

Objective

End-of-life decisions are based on objective and subjective criteria. Previous studies identified substantial subjective biases during end-of-life decision-making. We evaluated whether in-ICU patient’s birthday influenced management decisions.

Design

We used a case–control design in which patients spending their birthday in the ICU (cases) were matched to controls on center, gender, age, severity, type of admission, and length of ICU stay before birthday.

Setting

12 ICUs in French hospitals.

Patients

The cases and controls were patients with ICU admissions >48 h over a 10-year period.

Interventions

None.

Measurements and main results

Compared with the 1,042 controls, the 223 cases were more often trauma patients and received a larger number and longer durations of life-sustaining interventions. This increased intensity of life support occurred after, but not before, the birthday. The cases had longer ICU stay lengths. ICU and hospital mortality were not different between the two groups. End-of-life decisions were made in 22% and 24% of cases and controls, respectively. However, these decisions were made later in the cases than in the controls (18 [5–33] versus 9 [3–19] days).

Conclusions

Our finding that patients who spent their birthday in the ICU received a higher intensity of life-sustaining care and had longer ICU stays but did not have significantly different mortality rates compared with the controls suggests the use of nonbeneficial interventions. Staff members caring for patients whose birthdays fall during the ICU stay should be aware that this feature can bias end-of-life decisions, leading to an inappropriate level of care.

Keywords

Withholding treatment Intensive care units Decision-making Matched case–control study Medical futility