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

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Version 2 2024-06-03, 18:06
Version 1 2016-10-20, 14:17
journal contribution
posted on 2024-06-03, 18:06 authored by Neil OrfordNeil Orford, SL Milnes, N Lambert, L Berkeley, SE Lane, Nick SimpsonNick Simpson, T Elderkin, A Bone, Peter MartinPeter Martin, Charlie CorkeCharlie Corke, R Bellomo, M Bailey
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.

History

Journal

Critical care and resuscitation

Volume

18

Pagination

181-188

Location

Prahran, Vic.

ISSN

1441-2772

Language

eng

Publication classification

C Journal article, C1 Refereed article in a scholarly journal

Copyright notice

2016, College of Intensive Care Medicine of Australia and New Zealand

Issue

3

Publisher

College of Intensive Care Medicine of Australia and New Zealand