Triage decisions and bias against the elderly in European intensive care units

INTRODUCTION. Life and death triage decisions are made daily by physicians in ICUs. Many hospitals do not have adequate ICU resources and patients who might benefit from ICU are not always admitted, especially the elderly. METHODS. A prospective, observational study of triage decisions was performed in 11 ICUs in 7 European countries from September 2003 until March 1, 2005. All patients > 18 years whose health care professional explicitly requested admission to the ICU were included. Data collected for consecutive patients included age, SAPS II scores, whether the patient was accepted or rejected and 28-day mortality. RESULTS. Of the 8472 triages there were 7737 patients (pt). Of the 8472 triages, 6981 were accepted to ICU, 1491 (18%) rejected. 3795 (49%) pts were 65 or older. As the pt’s age increased, the refusal rate also increased (18-44- 191/1614- 12%; 45-64- 347/2328- 15%; 65-74- 337/1905- 18%; 75-84- 360/1576- 23%; >84- 112/314- 36%). Mortality was greater for older pts (18-44- 171/1566- 11%; 45-64- 497/2328- 21%; 65-74- 531/1905- 28%; 75-84- 580/1576- 37%; >84- 150/314- 48%; total 1929/7737- 25%). Differences between mortalities of accepted vs. rejected pts, however, were greatest for older pts (18-44- 148/1423- 10% vs 23/191- 12%; 45-64- 411/1981- 21% vs 86/347- 25%; 65-74- 413/1568- 26% vs 118/337- 35%; 75-84- 429/1216- 35% vs 151/360- 42%; >84- 86/202- 43% vs 64/112- 57%. Logistic regression showed less mortality for accepted vs rejected pts corrected for SAPS only for pts > 65 [OR- 0.56-0.77 (95%CI 0.35-0.98)] (p< 0.05). CONCLUSION. Despite the fact that elderly pts are rejected from ICUs more often than younger pts and have a higher mortality when admitted, the benefit of ICU survival appears greater for the elderly. Physicians should consider changing their triage practices considering the elderly.