Document Detail


Increased nonbeneficial care in patients spending their birthday in the ICU.
MedLine Citation:
PMID:  22323081     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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.
Authors:
Elie Azoulay; Maité Garrouste; Dany Goldgran-Toledano; Christophe Adrie; Adeline Max; Aurélien Vesin; Adrien Francais; Jean-Ralph Zahar; Yves Cohen; Bernard Allaouchiche; Benoît Schlemmer; Jean-François Timsit
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-2-10
Journal Detail:
Title:  Intensive care medicine     Volume:  -     ISSN:  1432-1238     ISO Abbreviation:  -     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-2-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Medical ICU, AP-HP, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France, elie.azoulay@sls.ap-hop-paris.fr.
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