Aggressiveness of care in the last days of life in the emergency department of a tertiary hospital in Korea

BMC Palliative Care

Table 2 Factors associated with receiving critical care at end-of-life in the emergency department

	No Critical Care (N = 134)	Critical Care (N = 88)		Univariate Logistic Regression
Variables	n (%)	n (%)	p-value^b	OR (95% CI)
Age (years)
≥ 75	61 (58.65)	43 (41.35)	0.626	ref
< 75	73 (61.86)	45 (38.14)		0.87 (0.51–1.50)
Sex
Female	50 (60.98)	32 (39.02)	0.886	ref
Male	84 (60.00)	56 (40.00)		1.04 (0.60–1.82)
Health insurance
Medicaid/None	17 (70.83)	7 (29.17)	0.267	ref
National Health Insurance	117 (59.09)	81 (40.91)		1.68 (0.67–4.24)
Serious illness^a
Yes	119 (65.38)	63 (34.62)	0.001	ref
No	15 (37.50)	25 (62.50)		3.14 (1.55–6.40)
Cancer (active)
Yes	95 (67.38)	46 (32.62)	0.005	ref
No	39 (48.15)	42 (51.85)		2.22 (1.27–3.89)
Place prior to ED visit
Others	43 (62.32)	26 (37.68)	0.689	ref
Home	91 (59.48)	62 (40.52)		1.13 (0.63–2.02)
KTAS level
3–5	15 (53.57)	13 (46.43)	0.432	ref
1–2	119 (61.34)	75 (38.66)		0.73 (0.33–1.61)
Advance care planning conversation
Before ED visit	39 (82.98)	8 (17.02)	< 0.001	ref
None	0 (0.00)	25 (100.00)		1
After ED visit	95 (63.33)	55 (36.67)		2.82 (1.23–6.47)
Advance statement
Yes	52 (86.67)	8 (13.33)	< 0.001	ref
No	82 (50.62)	80 (49.38)		6.34 (2.83–14.19)
Legal form documentation for LST implementation
Yes	85 (70.83)	35 (29.17)	0.001	ref
No	49 (48.04)	53 (51.96)		2.63 (1.51–4.57)
Palliative care consultation
Yes	24 (82.76)	5 (17.24)	0.005	ref
No	110 (56.99)	83 (43.01)		3.62 (1.33–9.89)

Abbreviations: ECOG Eastern Cooperative Oncology Group, ED Emergency department, EF Ejection fraction, FEV1 Forced expiratory volume in one second, KTAS Korean Triage and Acuity Scale, LST Life-sustaining treatment, NYHA New York Heart Association
^a Patients were considered to have serious illness if they were diagnosed as any of the followings [38]: cancer with distant metastases, a chronic obstructive pulmonary disease with oxygen demand or in need of hospitalization, end-stage renal disease on dialysis, congestive heart failure in need of hospitalization, liver cirrhosis in Child–Pugh class C, diabetes with severe complications (ischemic heart disease, peripheral vascular disease, and renal disease), amyotrophic lateral sclerosis, or dementia with evidence of illness or advanced disease
^b p-values were calculated using Pearson’s chi-squared test for age, sex, health insurance, serious illness, cancer, prior place to ED visit, advance statement, legal form documentation and palliative consultation, or Fisher’s exact test for ACP conversation

ISSN: 1472-684X