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

Garrouste-Orgeas, Maité; Montuclard, Luc; Timsit, Jean-François; Misset, Benoit; Christias, Marie; Carlet, Jean; Garrouste-Orgeas, Maité; Timsit, Jean-François
May 2003
Intensive Care Medicine;May2003, Vol. 29 Issue 5, p774
Academic Journal
journal article
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.


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