Journal ArticleDOI
Long-Term Outcomes After ICU Admission Triage in Octogenarians.
Finn H. Andersen,Hans Flaatten,Pål Klepstad,Turid Follestad,Kristian Strand,Andreas J. Krüger,Michael Hahn,Christian Buskop,Anne-Karin Rime,Reidar Kvåle +9 more
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TLDR
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.Abstract:
To describe ICU admission triage and outcomes in octogenarians.
Multicenter prospective observational study.
Three nonuniversity hospitals and three university hospitals in Norway.
Patients 80 years old or older who were referred for ICU admission from November 2013 to October 2014.
None.
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.
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.read more
Citations
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Contrasting treatment‐specific survival using double‐robust estimators
KyungMann Kim,Simon G. Thompson +1 more
Journal ArticleDOI
The status of intensive care medicine research and a future agenda for very old patients in the ICU
Hans Flaatten,Hans Flaatten,Dylan W. de Lange,Antonio Artigas,Du Bin,R. Moreno,Steffen Christensen,Gavin M. Joynt,Sean M. Bagshaw,Charles L. Sprung,Dominique Benoit,Marcio Soares,Bertrand Guidet +12 more
TL;DR: An expert panel proposes a research agenda for VOPs for the coming years, and suggests more appropriate triage, admission decisions based on shared decision-making and improved prediction models are also needed.
Journal ArticleDOI
Sepsis and Immunosenescence in the Elderly Patient: A Review.
TL;DR: Age, as alone factor, should not be used to determine treatment options because the poorer outcomes is thought to be due to the increased comorbidities and frailty in this group of patients.
Journal ArticleDOI
Caring for the critically ill patients over 80: a narrative review.
Bertrand Guidet,Bertrand Guidet,Bertrand Guidet,Helene Vallet,Jacques Boddaert,Dylan W. de Lange,Alessandro Morandi,Guillaume Leblanc,Antonio Artigas,Hans Flaatten,Hans Flaatten +10 more
TL;DR: Important steps in caring for critically ill older patients are discussed, from the triage to long-term outcome, with a focus on specific conditions in the very old patients.
Journal ArticleDOI
Clinical Frailty Scale (CFS) reliably stratifies octogenarians in German ICUs: a multicentre prospective cohort study.
Johanna M. Muessig,Amir M. Nia,Maryna Masyuk,Alexander Lauten,Anne Lena Sacher,Thorsten Brenner,Marcus Franz,Frank Bloos,Henning Ebelt,Stefan J. Schaller,Kristina Fuest,Christian Rabe,Thorben Dieck,Stephan Steiner,Tobias Graf,Rolf Alexander Jánosi,Patrick Meybohm,Philipp Simon,Stefan Utzolino,Tim Rahmel,Eberhard Barth,Michael Schuster,Malte Kelm,Christian Jung +23 more
TL;DR: The CFS is an easy determinable valuable tool for prediction of 30-day ICU survival in octogenarians, thus, it may facilitate decision-making for intensive care givers in Germany.
References
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Journal ArticleDOI
A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation☆
TL;DR: The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death fromComorbid disease for use in longitudinal studies and further work in larger populations is still required to refine the approach.
Journal Article
EuroQol : a new facility for the measurement of health-related quality of life
Journal ArticleDOI
A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study
TL;DR: The SAPS II, based on a large international sample of patients, provides an estimate of the risk of death without having to specify a primary diagnosis, and is a starting point for future evaluation of the efficiency of intensive care units.
Journal ArticleDOI
Karnofsky performance status revisited: reliability, validity, and guidelines.
TL;DR: Oncologists may train themselves to use the Karnofsky Performance Status in a standard way, which should increase reliability and validity of the KPS and has implications for patients and research studies that use KPS as a stratifying variable.
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