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Inicio Medicina Clínica (English Edition) Limiting ICU admission from emergency services and wards
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Vol. 157. Issue 11.
Pages 524-529 (December 2021)
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Vol. 157. Issue 11.
Pages 524-529 (December 2021)
Original article
Limiting ICU admission from emergency services and wards
Limitación del ingreso en unidades de cuidados intensivos desde los servicios de urgencias y las plantas de hospitalización
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Patricia Escudero-Achaa, Oihana Leizaolab, Noelia Lázaroc, Mónica Corderod, Ana María Cossíoe, Daniel Ballesterosf, Paula Recenag, Ana Isabel Tizónh, Manuel Palomoi, Maite Misis del Campoj, Santiago Freitak, Jorge Duertol, Naia Mas Bilbaom, Barbara Vidaln, Domingo González-Romeroo, Francisco Diaz-Dominguezp, Jaume Revueltoq, Maria Luisa Blascor, Monica Domezains, M.ª de la Concepción Pavía-Pesquerat, Miriam Pérez Ruizu, Angel Pobov, Inés Gomez-Acebow, Alejandro González-Castroa,
Corresponding author
e409@humv.es

Corresponding author.
, Grupo de Trabajo ADENI
a Hospital Universitario Marqués de Valdecilla, Santander, Spain
b Hospital Universitario Central de Asturias, Oviedo, Spain
c Hospital 12 de Octubre, Madrid, Spain
d Hospital Universitario de Álava, Vitoria-Gasteiz, Spain
e Hospital Universitario Virgen Macarena, Sevilla, Spain
f Hospital Puerta de Hierro, Madrid, Spain
g Hospital Universitario de Cabueñes, Gijón, Spain
h Complexo Hospitalario Universitario de Ourense, Ourense, Spain
i Hospital de Sagunto, Valencia, Spain
j Hospital Universitario Germans Trias i Pujol, Badalona, Spain
k Complexo Hospitalario Universitario Alvaro Cunqueiro, Vigo, Spain
l Hospital Clínico San Carlos, Madrid, Spain
m Hospital Galdakao-Usansolo, Galdakao, Spain
n Hospital Universitario de Castellón, Castelló de la Plana, Spain
o Complejo Universitario Insular Materno Infantil, Las Palmas, Spain
p Complejo Asistencial Universitario de León, León, Spain
q Hospital Universitario Puerta del Mar, Cádiz, Spain
r Hospital Clínico de Valencia, Valencia, Spain
s Hospital Universitario de Cruces, Bilbao, Spain
t Hospital San Pedro, Logroño, Spain
u Hospital de Jerez, Jerez, Spain
v Hospital Joan XXIII de Tarragona, Tarragona, Spain
w Departamento de Preventiva y Salud Pública, Facultad de Medicina, Universidad de Cantabria, Santander, Spain
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Tables (3)
Table 1. Clinical-demographic differences between patients assessed by intensive care medicine from the emergency department and from conventional hospital wards.
Table 2. Differences in variables associated with the time of consultation of intensive care medicine between emergency departments and conventional hospital wards.
Table 3. Differences in the variables associated with the decision to refuse admission to an intensive care unit as a measure of withholding/withdrawal of life support, between emergency services and conventional hospital wards.
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Abstract
Introduction

Decisions not to admit a patient to intensive care units (ICU) as a way of limiting life support treatment (LLST) is a practice that can affect the operation of the emergency services and the way in which patients die.

Methods

Post hoc analysis of the ADENI-UCI study. The main variable analysed was the reason for refusal of admission to the ICU as a measure of LLST. For the present post hoc analysis, the registered patients were divided into 2 groups: the patients assessed in the intensive medicine services from the emergency department and the patients assessed from the conventional hospitalization areas. Student t was used in the comparative statistics when the mean values of the patient sub-cohorts were compared. Categorical variables were compared with the χ2 tests.

Results

The ADENI-ICU study included 2284 decisions not to admit to the ICU as a measure of LLST. Estimated poor quality of life (p = 0.0158), the presence of severe chronic disease (P = 0.0169) and futility of treatment (P = 0.0006) were percentage decisions with greater weight within the population of hospitalized patients. The percentage of disagreement between the consulting physician and the intensivist was significantly lower in patients assessed from the emergency services (P = 0.0021).

Conclusions

There are appreciable differences in the reasons for consultation, as well as in those for refusal of admission to an ICU between the consultations made from an emergency department and a conventional hospitalization facility.

Keywords:
Emergencies
Limitation of life support treatments
Intensive care unit
Resumen
Introducción

Las decisiones de no ingresar a un paciente en las unidades de cuidados intensivos (UCI) como forma de limitación de un tratamiento de soporte vital (LTSV) es una práctica que puede afectar al funcionamiento de los servicios de urgencias y a la forma en que los pacientes mueren.

Métodos

Análisis post hoc del estudio ADENI-UCI. La principal variable analizada fue el motivo de negación de ingreso en UCI como medida de LTSV. Para el presente análisis post hoc se dividió a los enfermos registrados en 2 grupos: los enfermos consultados al servicio de medicina intensiva desde el área de urgencias y los pacientes consultados desde las áreas de hospitalización convencionales. En la estadística comparativa se utilizó la t de Student cuando se compararon los valores medios de las subcohortes de pacientes. Las variables categóricas se compararon con las pruebas de la χ2.

Resultados

El estudio ADENI-UCI incluía 2284 decisiones de no ingreso en UCI como medida de LTSV. La pobre calidad de vida estimada (p = 0,0158), la presencia de enfermedad crónica grave (p = 0,0169) y la futilidad de los tratamientos (p = 0,0006) fueron decisiones porcentualmente con más peso dentro de la población de pacientes hospitalizados. El porcentaje de desacuerdo entre el médico consultor y el intensivista fue menor de forma significativa en los enfermos valorados desde los servicios de urgencias (p = 0,0021).

Conclusiones

Existen diferencias apreciables en los motivos de consulta, así como en los de rechazo de ingreso en una UCI entre las consultas realizadas desde un servicio de urgencias y una planta de hospitalización convencional.

Palabras clave:
Urgencias
Limitación de los tratamientos de soporte vital
Unidad de cuidados intensivos

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