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End-of-life practices in 282 intensive care units: data from the SAPS 3 database.

Abstract : OBJECTIVE: To report incidence and characteristics of decisions to forgo life-sustaining therapies (DFLSTs) in the 282 ICUs who contributed to the SAPS3 database. METHODS: We reviewed data on DFLSTs in 14,488 patients. Independent predictors of DFLSTs have been identified by stepwise logistic regression. RESULTS: DFLSTs occurred in 1,239 (8.6%) patients [677 (54.6%) withholding and 562 (45.4%) withdrawal decisions]. Hospital mortality was 21% (3,050/14,488); 36.2% (1,105) deaths occurred after DFLSTs. Across the participating ICUs, hospital mortality in patients with DFLSTs ranged from 80.3 to 95.4% and time from admission to decisions ranged from 2 to 4 days. Independent predictors of decisions to forgo LSTs included 13 variables associated with increased incidence of DFLSTs and 7 variables associated with decrease incidence of DFLST. Among hospital and ICU-related variables, a higher number of nurses per bed was associated with increased incidence of DFLST, while availability of an emergency department in the same hospital, presence of a full time ICU-specialist and doctors presence during nights and week-ends were associated with a decreased incidence of DFLST. CONCLUSION: This large study identifies structural variables that are associated with substantial variations in the incidence and the characteristics of decisions to forgo life-sustaining therapies.
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https://www.hal.inserm.fr/inserm-00335308
Contributor : Aurélien Vesin <>
Submitted on : Wednesday, October 29, 2008 - 10:58:13 AM
Last modification on : Thursday, August 27, 2020 - 11:36:03 AM

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Elie Azoulay, Barbara Metnitz, Charles Sprung, Jean-François Timsit, François Lemaire, et al.. End-of-life practices in 282 intensive care units: data from the SAPS 3 database.. Intensive Care Medicine, Springer Verlag, 2008, epub ahead of print. ⟨10.1007/s00134-008-1310-6⟩. ⟨inserm-00335308⟩

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