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Long-Term Outcomes After ICU Admission Triage in Octogenarians

Andersen, Finn H. MD1,2; Flaatten, Hans MD, PhD3,4; Klepstad, Pål MD, PhD2,5; Follestad, Turid MSc, PhD6; Strand, Kristian MD, PhD7; Krüger, Andreas J. MD, PhD5; Hahn, Michael MD8; Buskop, Christian MD9; Rime, Anne-Karin MD9; Kvåle, Reidar MD, PhD3

doi: 10.1097/CCM.0000000000002098
Online Clinical Investigations

Objective: To describe ICU admission triage and outcomes in octogenarians.

Design: Multicenter prospective observational study.

Setting: Three nonuniversity hospitals and three university hospitals in Norway.

Patients: Patients 80 years old or older who were referred for ICU admission from November 2013 to October 2014.

Interventions: None.

Measurements and Main Results: Of the 355 included patients, 105 (29.6%) were refused ICU treatment. Risk factors for ICU refusal in patients considered “too ill/old” were advanced age and low functional status. Risk factors for ICU refusal in patients considered “too well” were advanced age, male sex, university hospital admission, comorbidity, and low Simplified Acute Physiology Score 3. Overall ICU survival was 71.6%. Hospital and 1-year survival were 56.0% and 40.0% in the ICU-admitted, 65.2% and 50.0% in the nonadmitted patients considered too well, and 32.7% and 11.5% in patients considered too ill/old, respectively. The adjusted Kaplan-Meier curves showed significantly lower survival for nonadmitted patients considered too ill/old than for ICU-admitted patients and nonadmitted patients considered too well. At follow-up, triage patients had lower health-related quality of life than an age- and sex-matched control group in the domains of self-care, usual care, and anxiety and depression, and a lower EuroQol visual analog scale scores.

Conclusions: Overall, 29.6% of the patients were refused ICU treatment. The adjusted survival analyses showed a significantly higher survival for ICU-admitted octogenarians than for nonadmitted patients who were considered too ill/old, indicating a benefit of ICU admission. Overall, the follow-up of triage patients showed lower health-related quality of life than an age- and sex-matched control population.

1Department of Anesthesia and Intensive Care, Møre and Romsdal Health Trust, Ålesund Hospital, Ålesund, Norway.

2Department of Circulation and Medical Imaging, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.

3Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.

4Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.

5Department of Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.

6Department of Public Health and General Practice, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.

7Department of Anesthesia and Intensive Care, Stavanger University Hospital, Stavanger, Norway.

8Department of Anesthesia and Intensive Care, Fonna Health Trust, Haugesund Hospital, Haugesund, Norway.

9Department of Anesthesia and Intensive Care, Østfold Hospital, Fredrikstad, Norway.

Dr Andersen conceived the study, helped coordinate data collection, performed the statistical analyses, and drafted the article. Drs Kvåle, Flaatten, and Klepstad made substantial contributions to the study conception and design and helped draft the article. Dr. Follestad contributed to the statistical analyses. Drs Andersen, Kvåle, Klepstad, Strand, Hahn, Buskop, Krüger, and Rime coordinated data collection at the local level. All authors read and approved the final article.

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Dr. Andersen is currently receiving a grant from the Møre and Romsdal Health Trust. The remaining authors have disclosed that they do not have any conflicts of interest.

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