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Prevalence, goals of care and long-term outcomes of patients with life-limiting illness referred to a tertiary ICU

Orford, Neil R., Milnes, Sharyn L., Lambert, Nigel, Berkeley, Laura, Lane, Stephen E., Simpson, Nicholas, Elderkin, Tania, Bone, Allison, Martin, Peter, Corke, Charlie, Bellomo, Rinaldo and Bailey, Michael 2016, Prevalence, goals of care and long-term outcomes of patients with life-limiting illness referred to a tertiary ICU, Critical care and resuscitation, vol. 18, no. 3, pp. 181-188.

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Title Prevalence, goals of care and long-term outcomes of patients with life-limiting illness referred to a tertiary ICU
Author(s) Orford, Neil R.
Milnes, Sharyn L.
Lambert, Nigel
Berkeley, Laura
Lane, Stephen E.
Simpson, Nicholas
Elderkin, Tania
Bone, Allison
Martin, Peter
Corke, Charlie
Bellomo, Rinaldo
Bailey, Michael
Journal name Critical care and resuscitation
Volume number 18
Issue number 3
Start page 181
End page 188
Total pages 8
Publisher College of Intensive Care Medicine of Australia and New Zealand
Place of publication Prahran, Vic.
Publication date 2016-09
ISSN 1441-2772
Keyword(s) Science & Technology
Life Sciences & Biomedicine
Critical Care Medicine
General & Internal Medicine
Summary OBJECTIVE: To describe the prevalence, characteristics, long-term outcomes and goals-of-care discussions of patients with objective indicators of life-limiting illnesses (LLIs) referred to the intensive care unit.

DESIGN, SETTING AND PATIENTS: A prospective, observational, cohort study of all adult inpatients referred to the ICU by the medical emergency team or by direct referral, during the period 30 August 2012 to 1 February 2013, at a tertiary teaching hospital in Australia.

MAIN OUTCOME MEASURES: Mortality, LLIs, discharge destination and documentation on goals of care in medical record.

RESULTS: A total of 649 of 1024 patients referred to the ICU had an LLI, and only 34.4% of these patients had goals of care documented. Overall, 49.2% were admitted to the ICU, 48.4% were discharged home, and the 1-year mortality was 35.1%. The most common LLI criteria were heart disease (52.2%), chronic obstructive pulmonary disease (24.8%) and frailty (23.7%). The highest 1-year mortality was associated with pre-hospital residence in a nursing home (64.9%), dementia (63.3%), cancer (60.8%) and frailty (50.6%). Analysis of patients by clinical trajectory showed that 1-year mortality was significantly higher for patients with cancer (59.6%), combined organ failure and frailty (47.3%), frailty (43.8%) and organ failure (23.6%), compared with patients with no LLI (P < 0.0001).

CONCLUSIONS: A high proportion of patients referred to the ICU have an LLI, and this is associated with prolonged hospital length of stay and a high 1-year mortality, and only one-quarter have documented discussions on goals of care. Patients with cancer-related and frailty-related LLIs have the worst survival trajectories.
Language eng
Field of Research 110399 Clinical Sciences not elsewhere classified
1103 Clinical Sciences
Socio Economic Objective 920204 Evaluation of Health Outcomes
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2016, College of Intensive Care Medicine of Australia and New Zealand
Free to Read? Yes
Persistent URL http://hdl.handle.net/10536/DRO/DU:30088025

Document type: Journal Article
Collections: School of Medicine
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.