Intensive Care Medicine

, Volume 36, Issue 5, pp 765–772 | Cite as

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

  • Philippe Le Conte
  • David Riochet
  • Eric Batard
  • Christelle Volteau
  • Bruno Giraudeau
  • Idriss Arnaudet
  • Laetitia Labastire
  • Jacques Levraut
  • Frédéric Thys
  • Dominique Lauque
  • Claude Piva
  • Jeannot Schmidt
  • David Trewick
  • Gilles Potel
Original

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 

Notes

Acknowledgments

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

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Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Philippe Le Conte
    • 1
  • David Riochet
    • 1
  • Eric Batard
    • 1
  • Christelle Volteau
    • 2
  • Bruno Giraudeau
    • 3
  • Idriss Arnaudet
    • 1
  • Laetitia Labastire
    • 1
  • Jacques Levraut
    • 4
  • Frédéric Thys
    • 5
  • Dominique Lauque
    • 6
  • Claude Piva
    • 7
  • Jeannot Schmidt
    • 8
  • David Trewick
    • 1
  • Gilles Potel
    • 1
  1. 1.Department of Emergency MedicineNantes University HospitalNantes Cedex 01France
  2. 2.Biostatistic DepartmentNantes University HospitalNantesFrance
  3. 3.INSERM CIC 202, CHRU de ToursUniversité François Rabelais ToursToursFrance
  4. 4.Department of Emergency MedicineNice University HospitalNiceFrance
  5. 5.Emergency DepartmentClinique Universitaire Saint LucBrusselsBelgium
  6. 6.Department of Emergency MedicineToulouse University HospitalToulouseFrance
  7. 7.Department of Emergency MedicineLimoges University HospitalLimogesFrance
  8. 8.Department of Emergency MedicineClermont Ferrand University HospitalClermontFrance

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