• Monica Escher, Mathieu Nendaz, Fabienne Scherer, Stéphane Cullati, and Thomas Perneger.
• Division of Palliative Medicine, Geneva University Hospitals, Geneva, Switzerland.
• Palliat Med. 2021 Jan 1; 35 (1): 161-168.

BackgroundLong-term survival and functional outcomes should influence admission decisions to intensive care, especially for patients with advanced disease.AimTo determine whether physicians' predictions of long-term prognosis influenced admission decisions for patients with and without advanced disease.DesignA prospective study was conducted. Physicians estimated patient survival with intensive care and with care on the ward, and the probability of 4 long-term outcomes: leaving hospital alive, survival at 6 months, recovery of functional status, and recovery of cognitive status. Patient mortality at 28 days was recorded. We built multivariate logistic regression models using admission to the intensive care unit (ICU) as the dependent variable.Setting/ParticipantsICU consultations for medical inpatients at a Swiss tertiary care hospital were included.ResultsOf 201 evaluated patients, 105 (52.2%) had an advanced disease and 140 (69.7%) were admitted to the ICU. The probability of admission was strongly associated with the expected short-term survival benefit for patients with or without advanced disease. In contrast, the predicted likelihood that the patient would leave the hospital alive, would be alive 6 months later, would recover functional status, and would recover initial cognitive capacity was not associated with the decision to admit a patient to the ICU. Even for patients with advanced disease, none of these estimated outcomes influenced the admission decision.ConclusionsICU admissions of patients with advanced disease were determined by short-term survival benefit, and not by long-term prognosis. Advance care planning and developing decision-aid tools for triage could help limit potentially inappropriate admissions to intensive care.

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