• Neil R Orford, Sharyn L Milnes, Nigel Lambert, Laura Berkeley, Stephen E Lane, Nicholas Simpson, Tania Elderkin, Allison Bone, Peter Martin, Charlie Corke, Rinaldo Bellomo, and Michael Bailey.
• Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia. neilo@barwonhealth.org.au.
• Crit Care Resusc. 2016 Sep 1; 18 (3): 181-8.

ObjectiveTo describe the prevalence, characteristics, long-term outcomes and goals-of-care discussions of patients with objective indicators of life-limiting illnesses (LLIs) referred to the intensive care unit.Design, Setting And PatientsA prospective, observational, cohort study of all adult inpatients referred to the ICU by the medical emergency team or by direct referral, during the period 30 August 2012 to 1 February 2013, at a tertiary teaching hospital in Australia.Main Outcome MeasuresMortality, LLIs, discharge destination and documentation on goals of care in medical record.ResultsA total of 649 of 1024 patients referred to the ICU had an LLI, and only 34.4% of these patients had goals of care documented. Overall, 49.2% were admitted to the ICU, 48.4% were discharged home, and the 1-year mortality was 35.1%. The most common LLI criteria were heart disease (52.2%), chronic obstructive pulmonary disease (24.8%) and frailty (23.7%). The highest 1-year mortality was associated with pre-hospital residence in a nursing home (64.9%), dementia (63.3%), cancer (60.8%) and frailty (50.6%). Analysis of patients by clinical trajectory showed that 1-year mortality was significantly higher for patients with cancer (59.6%), combined organ failure and frailty (47.3%), frailty (43.8%) and organ failure (23.6%), compared with patients with no LLI (P < 0.0001).ConclusionsA high proportion of patients referred to the ICU have an LLI, and this is associated with prolonged hospital length of stay and a high 1-year mortality, and only one-quarter have documented discussions on goals of care. Patients with cancer-related and frailty-related LLIs have the worst survival trajectories.

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