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Patients in US 5 times more likely to spend last days in ICU than patients in England
Date:10/22/2009

to a greater degree than it is in the U.S., and there are consequently implicit and explicit decisions regarding who gets those limited services. We wished to examine what different decisions are made."

Dr. Wunsch and colleagues examined data from the Hospital Episodes Statistics database (in England) and all hospital discharge databases of seven states (FL, MA, NJ, NY, TX, VA, WA) in the U.S. They found that of all hospital discharges, only 2.2 percent in England received intensive care, compared to 19.3 percent in the U.S.

They also found that hospital mortality among those who received intensive care was almost three times higher in England than in the U.S. (19.6 percent vs. 7.4 percent). But when examining deaths overall, only 10.6 of hospital deaths in England involved the ICU, whereas 47.1 in the U.S. did. Of those over 85, only 1.3 percent received ICU care in England vs. 11 percent in the U.S. But young adults and children received ICU services at similar rates in both countries. "These numbers need to be interpreted with caution," explains Dr. Wunsch, "as the differences in mortality for ICU patients likely reflect the higher severity of illness of patients admitted in the first place in England. The data do bring up the interesting question of how much intensive care is beneficial. Doing more may not always be better."

While these findings highlight important differences within the two countries' use of intensive care services, the research was not designed to determine the direct impact of these differences. Past surveys have suggested that the majority of people would prefer not to die in the hospital, but given that so many do, questions about use of intensive interventions remain.

"Whether less intensive care for very elderly patients who are dying is a form of rationing, or is actually better recognition of what constitutes appropriate care at the end of life warrants further research," said Dr. Wunsch. "These fin
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Contact: Keely Savoie
ksavoie@thoracic.org
212-305-8620
American Thoracic Society
Source:Eurekalert

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