The probability of having advanced médical interventions is associated with age in out-of-hospital life-threatening situations

Détails

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Etat: Public
Version: Après imprimatur
ID Serval
serval:BIB_BEAB6C73EC14
Type
Thèse: thèse de doctorat.
Collection
Publications
Institution
Titre
The probability of having advanced médical interventions is associated with age in out-of-hospital life-threatening situations
Auteur(s)
Tavares Vania
Directeur(s)
Burnand Bernard
Détails de l'institution
Université de Lausanne, Faculté de biologie et médecine
Adresse
Faculté de biologie et de médecine
Université de Lausanne
CH-1015 Lausanne
SUISSE

Statut éditorial
Acceptée
Date de publication
2016
Langue
anglais
Résumé
Background: The use of out-of-hospital emergency medical services by old and very old individuals is increasing.
These patients frequently require complex evaluation and decision-making processes to determine a strategy of care, therapeutic choices or withdrawal of care in life-threatening situations. During out-of-hospital missions, thorough decision-making is difficult because of the limited amount of time and lack of direct access to medical charts or to pre-existing advance directives. In this setting, age may be used as a proxy to determine strategy of care, therapeutic choices or withdrawal of care, particularly in relation to advanced medical interventions. We aimed to determine how an emergency physician’s initiation of out-of-hospital advanced medical interventions varies with the patient’s age.
Methods: We performed a retrospective analysis of the missions conducted by the emergency physicians-staffed emergency medical services in a Swiss region. We used logistic regression analysis to determine whether the probability of receiving an advanced medical intervention was associated with the patient’s age.
Results: Among 21,922 out-of-hospital emergency adult missions requiring an emergency physician, the probability of receiving an advanced medical intervention decreased with age. It was highest among those aged 18 – 58 years and significantly lower among those aged = 89 years (OR = 0.66; 95 % CI: 0.53 – 0.82). The probability of cardiopulmonary resuscitation attempts progressively decreased with age and was significantly lower for the three oldest age deciles (80 – 83, 84 – 88 and = 89 years).
Conclusion: The number of out-of-hospital advanced medical interventions significantly decreased for patients aged = 89 years. It is unknown whether this lower rate of interventions was related only to age or to other medical characteristics of these patients, such as the number or severity of comorbidities. Thus, further studies are needed to confirm whether this observation corresponds to underuse of advanced medical interventions in very old patients.
Mots-clé
Ageing, Out-of-hospital emergency medical services, Cardiopulmonary resuscitation, Critical care medicine, Decision-making
Création de la notice
26/01/2017 13:36
Dernière modification de la notice
20/08/2019 16:32
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