PITTSBURGH, April 6 Although most Americans say they would prefer a low-tech approach to death, the opposite is happening with more than 20 percent of terminally ill patients dying in intensive care, according to an article in the March issue of Critical Care Medicine, the journal of the Society of Critical Care Medicine.

"This is the first study to provide national scale to the often discussed end-of-life public health issue," says Derek C. Angus, M.D., Ch.B., M.P.H., professor of critical care medicine and vice chair of research in the department of critical care medicine at the University of Pittsburgh School of Medicine. "Previously there were no reliable estimates of the magnitude of this situation."

In light of their findings, the researchers are concerned that hospitals and intensive care units (ICU) are not prepared to deliver end-of-life care to the population older than 65 years, which is rapidly expanding.

The researchers analyzed hospital discharge data from 1999 for six states (Florida, Massachusetts, New Jersey, New York, Virginia and Washington) and the National Death Index to estimate the use of critical care at the end-of-life.

The researchers found that of the 552,157 deaths they were studying, 38.3 percent occurred in the hospital and 22.4 percent occurred following ICU admission. Nationally projected, this means more than one-half million Americans die annually following ICU admission.

End-of-life ICU use was highest (43 percent) among infants, ranged from 18 percent to 26 percent among older children and adults and fell to 14 percent for people older than 85 years.

Additionally, the researchers found that terminally ill ICU patients had an average length of stay of 12.9 days at a cost of $24,541 and non-ICU hospitalization of the terminally ill had an average stay of 8.9 days at a cost of $8,548.

Nine out of 10 Americans say they would prefer to die at home; however, 20 percent die after r
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6-Apr-2004

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