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Master thesis

Facteurs influençant le tri des patients à admettre dans une réanimation médicale et survie des patients

Abstract : Objective: To describe triage decisions process and subsequent outcomes on patient referred for but refused to ICU, comparatively to patients admitted. To assess the accuracy of ICU physicians in the prediction of outcome versus the M.P.M[indice]O score. Design: Prospective descriptive single-center cohort study.Setting: Eleven beds medical ICU in an acute-care 945-bed, tertiary care teaching hospital. Measurements and results: Time of referral, age, underlying diseases, admission diagnoses, Mortality Probability Model (MPM[indice]O) score, information available to ICU physicians, reasons for refusal, physician?s prognosis of survival, and mortality were recorded. Of the 732 patients (91% medical), 236 (32.2%) were refused. Reasons for refusal were patient location, bed availability, last bed available phenomenon, refusal through telephone, patient age, medical reason, underlying disease, and disability. Mortality among refused patient is higher (38.5% vs. 24.8%), even when patients are secondarily admitted to ICU (53.8% vs.24.8%). Physicians are wrong half the time when they are asked to make survival assessment of refused patients with the most critical condition, besides that MPM[indice]O did better. Conclusion: Refusal of ICU admission is a complex process, and is related to patient?s dependant factors, and to logistic factors such as bed availability. Scores that are more accurate than MPM[indice]O are needed, but in the meantime this one can still be useful for limiting the triage's mistakes done by physicians for the most severe condition patients. The increase of intermediate care beds are needed to limit these factor in order comply to fair allocation of scarce ICU?s resources.
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Master thesis
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Submitted on : Wednesday, March 14, 2018 - 2:54:34 PM
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Alexandre Lai. Facteurs influençant le tri des patients à admettre dans une réanimation médicale et survie des patients. Sciences du Vivant [q-bio]. 2011. ⟨hal-01732310⟩



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