Admission en réanimation du sujet âgé à partir du service des urgences. État des lieux

Choosing whether to admit or refuse an elderly patient to ICU is a challenging decision. There are no guidelines for this specific population and no prospective study available to help emergency and intensive-care physician. When considering refusal rate, there are wide variations and as a consequence, the percentage of elderly patients varies considerably from one centre to another. We performed a prospective, multicenter, observational study focusing on patients over 80 presenting to the emergency department with a condition potentially requiring ICU admission. Among 2646 patients, 662 (26%) were referred to ICU physicians by emergency physicians and only 330 (13% of the whole population) were finally admitted in ICU. The adjusted admission rate varied considerably between two centers. The multivariate analysis identified independent factors for non-ICU admission proposal (OR-CI 95%): age (1.04; 1.02-1.04), living alone (1.27; 0.99-1.62), cancer (1.61; 1.09-2.38), psychiatric treatment (1.42; 1.10-1.81), loss of functional status and severity. Our study provides strong evidence for the need of recommendations regarding admission of elderly patients in intensive care units.