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

abstract

  • 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.

authors

  • Orford, NR
  • Milnes, SL
  • Lambert, N
  • Berkeley, L
  • Lane, SE
  • Simpson, N
  • Elderkin, T
  • Bone, A
  • Martin, P
  • Corke, C
  • Bellomo, R
  • Bailey, M

publication date

  • September 1, 2016