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Intensive Care Medicine

, Volume 29, Issue 5, pp 774–781 | Cite as

Triaging patients to the ICU: a pilot study of factors influencing admission decisions and patient outcomes

  • Maité Garrouste-OrgeasEmail author
  • Luc Montuclard
  • Jean-François Timsit
  • Benoit Misset
  • Marie Christias
  • Jean Carlet
Original

Abstract

Objective

To assess the appropriateness of ICU triage decisions.

Design

Prospective descriptive single-center study.

Setting

Ten-bed, medical-surgical ICU in an acute-care 460-bed, tertiary care hospital.

Patients

All patients triaged for admission were entered prospectively.

Interventions

None.

Measurements and main results

Age, underlying diseases, admission diagnoses, Mortality Probability Model (MPM0) score, information available to ICU physicians, and mortality were recorded. Of the 334 patients (96% medical), 145 (46.4%) were refused. Reasons for refusal were being too-sick-to-benefit (48, 14%) and too-well-to-benefit (93, 28%). Factors independently associated with refusal were patient location, ICU physician seniority, bed availability, patient age, underlying diseases, and disability. Hospital mortality was 23% and 27% for patients admitted to our ICU and other ICUs, respectively, and 7.5% and 60% for patients too well and too sick to benefit, respectively. In the multivariate Cox model, McCabe = 1 [hazard ratio (HR), 0.44 (95% CI, 0.24–0.77), P=0.001], living at home without help (HR, 0.440, 95% CI, 0.28–0.68, P=0.0003), and immunosuppression (HR, 1.91, 95% CI, 1.09–3.33, P=0.02) were independent predictors of hospital death. Neither later ICU admission nor refusal was associated with cohort survival. MPM0 was not associated with hospital mortality.

Conclusions

Refusal of ICU admission was related to the ability of the triaging physician to examine the patient, ICU physician seniority, patient age, underlying diseases, self-sufficiency, and number of beds available. Specific training of junior physicians in triaging might bring further improvements. Scores that are more accurate than the MPM0 are needed.

Keywords

Intensive care unit Triage Ethics Hospital bed capacity Decision-making Mortality 

Notes

Acknowledgements

The authors thank Dr Antoinette Wolfe, for her help in preparing this manuscript and Corinne Alberti for her statistical comments.

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Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Maité Garrouste-Orgeas
    • 1
    Email author
  • Luc Montuclard
    • 1
  • Jean-François Timsit
    • 2
    • 3
  • Benoit Misset
    • 1
  • Marie Christias
    • 1
  • Jean Carlet
    • 1
  1. 1.Medical-Surgical ICUSaint Joseph HospitalParisFrance
  2. 2.Medical and Infectious Diseases ICUBichat University HospitalParisFrance
  3. 3.Medical Computer Science and Biostatistics DepartmentSaint Louis University HospitalParisFrance

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