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Outcomes in patients perceived as receiving excessive care by ICU physicians and nurses: differences between patients < 75 and ≥ 75 years of age?

The result's identifiers

  • Result code in IS VaVaI

    <a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00023001%3A_____%2F23%3A00084168" target="_blank" >RIV/00023001:_____/23:00084168 - isvavai.cz</a>

  • Alternative codes found

    RIV/00216208:11110/23:10469584

  • Result on the web

    <a href="https://www.sciencedirect.com/science/article/pii/S0012369223005159?via%3Dihub" target="_blank" >https://www.sciencedirect.com/science/article/pii/S0012369223005159?via%3Dihub</a>

  • DOI - Digital Object Identifier

    <a href="http://dx.doi.org/10.1016/j.chest.2023.04.018" target="_blank" >10.1016/j.chest.2023.04.018</a>

Alternative languages

  • Result language

    angličtina

  • Original language name

    Outcomes in patients perceived as receiving excessive care by ICU physicians and nurses: differences between patients < 75 and ≥ 75 years of age?

  • Original language description

    Background: The benefit of the ICU for older patients is often debated. There is little knowledge on subjective impressions of excessive care in ICU nurses and physicians combined with objective patient data in real-life cases. Research Question: Is there a difference in treatment limitation decisions and 1-year outcomes in patients &lt; 75 and ≥ 75 years of age, with and without concordant perceptions of excessive care by two or more ICU nurses and physicians? Study Design and Methods: This was a reanalysis of the prospective observational DISPROPRICUS study, performed in 56 ICUs. Nurses and physicians completed a daily questionnaire about the appropriateness of care for each of their patients during a 28-day period in 2014. We compared the cumulative incidence of patients with concordant perceptions of excessive care, treatment limitation decisions, and the proportion of patients attaining the combined end point (death, poor quality of life, or not being at home) at 1 year across age groups via Cox regression with propensity score weighting and Fisher exact tests. Results: Of 1,641 patients, 405 (25%) were ≥ 75 years of age. The cumulative incidence of concordant perceptions of excessive care was higher in older patients (13.6% vs 8.5%; P &lt;.001). In patients with concordant perceptions of excessive care, we found no difference between age groups in risk of death (1-year mortality, 83% in both groups; P &gt;.99; hazard ratio [HR] after weighting, 1.11; 95% CI, 0.74-1.65), treatment limitation decisions (33% vs 31%; HR after weighting, 1.11; 95% CI, 0.69-2.17), and reaching the combined end point at 1 year (90% vs 93%; P =.546). In patients without concordant perceptions of excessive care, we found a difference in risk of death (1-year mortality, 41% vs 30%; P &lt;.001; HR after weighting, 1.38; 95% CI, 1.11-1.73) and treatment limitation decisions (11% vs 5%; P &lt;.001; HR, 2.11; 95% CI, 1.37-3.27); however, treatment limitation decisions were mostly documented prior to ICU admission. The risk of reaching the combined end point was higher in the older adults (61.6% vs 52.8%; P &lt;.001). Interpretation: Although the incidence of perceptions of excessive care is slightly higher in older patients, there is no difference in treatment limitation decisions and 1-year outcomes between older and younger patients once patients are identified by concordant perceptions of excessive care. Additionally, in patients without concordant perceptions, the outcomes are worse in the older adults, pleading against ageism in ICU nurses and physicians. © 2023 American College of Chest Physicians

  • Czech name

  • Czech description

Classification

  • Type

    J<sub>imp</sub> - Article in a specialist periodical, which is included in the Web of Science database

  • CEP classification

  • OECD FORD branch

    30221 - Critical care medicine and Emergency medicine

Result continuities

  • Project

  • Continuities

    N - Vyzkumna aktivita podporovana z neverejnych zdroju

Others

  • Publication year

    2023

  • Confidentiality

    S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Data specific for result type

  • Name of the periodical

    Chest

  • ISSN

    0012-3692

  • e-ISSN

    1931-3543

  • Volume of the periodical

    164

  • Issue of the periodical within the volume

    3

  • Country of publishing house

    US - UNITED STATES

  • Number of pages

    11

  • Pages from-to

    656-666

  • UT code for WoS article

    001077483600001

  • EID of the result in the Scopus database

    2-s2.0-85167975686