[Emergency room deaths: 3-month retrospective analysis].
ABSTRACT Determine the characteristics of patients who died in the emergency unit and assess the number for whom care was limited or withdrawn.
A 3-month single-center retrospective study of all the patients who died in the emergency room. Bivariate analysis was used to compare the clinical characteristics of patients who died despite maximum care (MC) with those for whom care was limited (LC).
84 patients died during the study period: 48 men and 36 women (mean age: 73 +/- 18 years). Half had normal mobility (43 patients, 50%), and 35 (40%) lived at home. Nearly all (72 patients, 72%) had a severe chronic disease. In descending order, death was ascribed to neurological (n = 22, 24%), cardiac (n = 14, 15%), septic (n = 13, 14%) and respiratory (n = 9, 10%) causes. The decision was made to limit or stop active care for 73 patients (84%) and recorded in 48 case files (55%). The principal differences between patients receiving MC and LC were respectively C and D Knaus classification and their age.
Death is frequent in emergency units and often strikes elderly patients with impaired mobility and severe chronic diseases. The decisions to limit or stop active care are the predominant direct cause, but their modalities warrant further exploration in a prospective study.
- SourceAvailable from: Redouane Abouqal[show abstract] [hide abstract]
ABSTRACT: Withdrawing and withholding life-support therapy (WH/WD) are undeniably integrated parts of medical activity. However, Emergency Department (ED) might not be the most appropriate place to give end-of life (EOL) care; the legal aspects and practices of the EOL care in emergency rooms are rarely mentioned in the medical literature and should be studied. The aims of this study were to assess frequency of situations where life-support therapies were withheld or withdrawn and modalities for implement of these decisions. A survey of patients who died in a Moroccan ED was performed. Confounding variables examined were: Age, gender, chronic underlying diseases, acute medical disorders, APACHE II score, Charlson Comorbidities Index, and Length of stay. If a decision of WH/WD was taken, additional data were collected: Type of decision; reasons supporting the decision, modalities of WH/WD, moment, time from ED admission to decision, and time from processing to withhold or withdrawal life-sustaining treatment to death. Individuals who initiated (single emergency physician, medical staff), and were involved in the decision (nursing staff, patients, and families), and documentation of the decision in the medical record. 177 patients who died in ED between November 2009 and March 2010 were included. Withholding and withdrawing life-sustaining treatment was applied to 30.5% of all patients who died. Therapies were withheld in 24.2% and were withdrawn in 6.2%. The most reasons for making these decisions were; absence of improvement following a period of active treatment (61.1%), and expected irreversibility of acute disorder in the first 24 h (42.6%). The most common modalities withheld or withdrawn life-support therapy were mechanical ventilation (17%), vasopressor and inotrops infusion (15.8%). Factors associated with WH/WD decisions were older age (OR = 1.1; 95%IC = 1.01-1.07; P = 0.001), neurological acute medical disorders (OR = 4.1; 95%IC = 1.48-11.68; P = 0.007), malignancy (OR = 7.7; 95%IC = 1.38-8.54; P = 0.002) and cardiovascular (OR = 3.4;95%IC = 2.06-28.5;P = 0.008) chronic underlying diseases. Life-sustaining treatment were frequently withheld or withdrawn from elderly patients with underlying chronic cardiovascular disease or metastatic cancer or patients with acute neurological medical disorders in a Moroccan ED. Religious beliefs and the lack of guidelines and official Moroccan laws could explain the ethical limitations of the decision-making process recorded in this study.BMC Emergency Medicine 08/2011; 11:12.