Quality of end-of-life communication in 2 high-risk ICU cohorts: a retrospective cohort study

Article Figures & Tables

Table 1:

Patient and illness characteristics among 2 ICU cohorts, 2000–2017

Variable	No. (%) of cohort^*
Variable	Nursing home n = 230	ECMO n = 109
Age, yr
Mean ± SD	72.0 ± 10.6	51.8 ± 15.8
Median (IQR)	73 (64–80)	56 (44–64)
Sex, female	103 (44.8)	45 (41.3)
Year of admission
2000–2004	5 (2.2)	0
2005–2009	70 (30.4)	8 (7.3)
2010–2014	88 (38.3)	60 (55.0)
2015–2017	67 (29.1)	41 (37.6)
Location of residence
Urban		77 (70.6)
Rural		26 (23.9)
Out-of-province or nursing home resident		6 (5.5)
Socioeconomic status quintile
1 (lowest income)		29 (28.2)
2		24 (23.3)
3		11 (10.7)
4		17 (16.5)
5 (highest income)		22 (21.4)
Category of primary diagnosis at admission
Cardiovascular	52 (21.7)	59 (54.1)
Infectious	78 (33.9)	26 (23.9)
Respiratory	47 (20.4)	23 (21.1)
All others	55 (23.9)	1 (0.9)
Disease severity
APACHE II score, mean ± SD	22.4 ± 6.4	28.5 ± 8.1
APACHE II score, median (IQR)	22 (17–27)	27 (22–35)
GCS, mean ± SD	12.0 ± 3.4	8.3 ± 4.6
GCS, median (IQR)	13 (10–15)	7 (3–13)
APS, mean ± SD	12.9 ± 4.8	18.7 ± 6.0
APS, median (IQR)	13 (9–16)	18 (14–23)
APS-neuro score, mean ± SD	10.1 ± 5.4	12.0 ± 7.1
APS-neuro score, median (IQR)	10 (6–14)	12 (7–17)
Elapsed ACP time, d
Mean ± SD,	2.9 ± 6.2	9.1 ± 16.3
Median (IQR)	1.0 (1–2)	4.0 (1–13)
ECMO type
Venovenous with or without arteriovenous		16 (14.7)
Arteriovenous only		91 (83.5)
Level of care^†
Resuscitation	56 (24.3)	44 (40.4)
Medical	90 (39.1)	6 (5.5)
Comfort care	57 (24.8)	45 (41.3)
Missing	27 (11.8)	14 (12.8)
Hospital length of stay, d
Mean ± SD	20.1 ± 33.4	33.8 ± 35.1
Median (IQR)	11 (6–19)	20 (9–48)
Hospital death	69 (30.0)	51 (46.8)

Note: APACHE = acute physiology and chronic health evaluation, APS = acute physiology score, APS-neuro score = APS score with neurologic component removed, ECMO = extracorporeal membrane oxygenation, elapsed ACP time = elapsed advance care planning time (i.e., interval between ICU admission and first chart documentation of the level of care), GCS = Glasgow Coma Scale, ICU = intensive care unit, IQR = interquartile range, SD = standard deviation.
↵* Unless indicated otherwise.
↵† Least aggressive level of care recorded.

Table 2:

Quality of end-of-life communication among 2 ICU cohorts, 2000–2017, unadjusted values^*

Weighted scores^*	Nursing home cohort	ECMO cohort	p value^†
Composite measure of EOL communication^*
Mean ± SD	48.5 ± 25.8	49.1 ± 25.9	0.67
Median (IQR)	56.2 (28.4–73.8)	52.2 (27.5–68.9)	0.86
Goals of care communication subscore
Mean ± SD	39.9 ± 28.5	44.7 ± 29.1	0.17
Median (IQR)	43.4 (8.2–63.5)	50.0 (15.2–70.5)	0.14
Documentation subscore
Mean ± SD	70.9 ± 28.2	60.3 ± 27.1	0.001
Median (IQR)	80.3 (62.6–83.5)	63.8 (42.9–83.5)	0.001

Note: ECMO = extracorporeal membrane oxygenation, EOL = end-of-life, IQR = interquartile range, SD = standard deviation.
↵* Measures range 0–100.
↵† Mean comparison via unpaired Student t test.
Median comparison via Mann–Whitney test.

Table 3:

Median regression results for composite measure of end-of-life communication among 2 ICU cohorts, 2000–2017

Variable	Coefficient (95% CI)
Cohort
Nursing home cohort	Reference
ECMO cohort	−0.56 (−13.15 to 12.02)
Age (per year)	0.50 (0.21 to 0.78)^*
Sex
Male	Reference
Female	−2.29 (−12.21 to 7.63)
Year of admission (per year)	1.69 (0.54 to 2.84)^*
Glasgow Coma Scale score (per point)	−1.84 (−3.21 to −0.47)^*
APS-neuro score (per point)	0.72 (−0.18 to 1.63)
Category of primary diagnosis at admission
Cardiovascular	Reference
Infectious	0.93 (−9.02 to 10.88)
Respiratory	−8.56 (−24.16 to 7.05)
Other	−3.42 (−15.76 to 8.92)

Note: APS-neuro score = acute physiologic score with neurologic component removed, CI = confidence interval, ECMO = extracorporeal membrane oxygenation
↵* p value significant after adjustment for multiple comparisons using the 0.05 false discovery rate threshold.