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Determinants and outcomes associated with decisions to deny or to delay intensive care unit admission in Morocco

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Abstract

Purpose

To report determinants and outcomes associated with decisions to deny or to delay intensive care unit (ICU) admission in critically ill patients.

Methods

An observational prospective study over a 6-month period. All adult patients triaged for admission to a medical ICU were included prospectively. Age, gender, reasons for requesting ICU admission, severity of underlying disease, severity of acute illness, mortality and ICU characteristics were recorded. Multinomial logistic regression analysis was used for evaluating predicting factors of refused ICU admission.

Results

ICU admission was requested for 398 patients: 110 were immediately admitted (27.8%), 142 were never admitted (35.6%), and 146 were admitted at a later time (36.6%). The reasons for refusal were: too sick to benefit (31, 10.8%), too well to benefit (55, 19.1%), unit full (117, 40.6%), and more data about the patient were needed to make a decision (85, 29.5%). Multivariate analysis revealed that late ICU admission was associated with the lack of available ICU beds (OR 1.91; 95% CI 1.46–2.50; p = 0.003), cardiac disease (OR 7.77; 95% CI 2.41–25.04; p < 0.001), neurological disease (OR 3.78; 95% CI 1.40–10.26; p = 0.009), shock and sepsis (OR 2.55; 95% CI 1.06–6.13; p = 0.03), and metabolic disease (OR 2.84; 95% CI 1.11–7.30; p = 0.02). Factors for ICU refusal for never admitted patients were: severity of acute illness (OR 4.83; 95% CI 1.11–21.01; p = 0.03), cardiac disease (OR 14.26; 95% CI 3.95–51.44; p < 0.001), neurological disease (OR 4.05; 95% CI 1.33–12.28; p = 0.01) and lack of available ICU beds (OR 6.26; 95% CI 4.14–9.46; p < 0.001). Hospital mortality was 33.3% (37/110) for immediately admitted patients, 43.8% (64/146) for patients admitted later and 49.3% (70/142) for never admitted patients.

Conclusion

Refusal of ICU admission was correlated with the severity of acute illness, lack of ICU beds and reasons for admission request. Further efforts are needed to define which patients are most likely to benefit from ICU admission and to improve the accuracy of data on ICU refusal rates.

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Acknowledgments

We thank I. Khoudri, MD, for assistance with and reviewing of this manuscript.

Author information

Authors and Affiliations

  1. Medical Intensive Care Unit, Ibn Sina University Hospital, 10000, Rabat, Morocco

    Maha Louriz, Khalid Abidi, Mostafa Akkaoui, Naoufel Madani, Jihane Belayachi, Tarek Dendane, Amine Ali Zeggwagh & Redouane Abouqal

  2. Carolinas Medical Center North-East, Concord, NC, USA

    Kamal Chater

  3. Laboratory of Biostatistics, Clinical and Epidemiological Research, Faculté de Médecine et Pharmacie, Université Mohamed V, 10000, Rabat, Morocco

    Amine Ali Zeggwagh & Redouane Abouqal

Authors
  1. Maha Louriz
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  2. Khalid Abidi
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  3. Mostafa Akkaoui
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  6. Jihane Belayachi
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  8. Amine Ali Zeggwagh
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  9. Redouane Abouqal
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Corresponding author

Correspondence to Redouane Abouqal.

Additional information

M. Louriz and K. Abidi contributed equally to the work.

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Louriz, M., Abidi, K., Akkaoui, M. et al. Determinants and outcomes associated with decisions to deny or to delay intensive care unit admission in Morocco. Intensive Care Med 38, 830–837 (2012). https://doi.org/10.1007/s00134-012-2517-0

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  • DOI: https://doi.org/10.1007/s00134-012-2517-0

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