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One in three older inpatients may die following emergency intubation

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A large number of older patients either die in hospital or are discharged directly to a nursing home following intubation in the emergency department, a major US study has revealed.

Researchers noted that that intubation in the emergency department was common and could prevent a patient from dying from a reversible condition.

“A surprisingly large number of older patients either died in the hospital or were discharged to a nursing home”

Kei Ouchi

But, while the benefits of such intubation for young and otherwise healthy patients were clear, they said it was less obvious whether the benefits of intubation outweighed the risks in older patients.

The study, by researchers at Brigham and Women’s Hospital in Boston, investigated the outcomes for patients aged 65 and older after emergency intubation across a variety of conditions and disease.

The retrospective study examined the outcomes of more than 41,000 patients who were intubated in the emergency departments from 262 hospitals across the US between 2008 and 2015.

The study found that, overall, 33% of these patients died in the hospital after receiving intubation, 24% were discharged home and 41% were discharged to another location such as a nursing home.

Inpatient mortality following intubation was worse for those over 90 than any other group, with 50% of such patients dying in the hospital following intubation and just 14% being discharged home.

However, the outcomes were not drastically better for younger patients, with 29% aged between 65 and 74 dying in hospital following emergency intubation, and only 31% of being discharged home.

Brigham and Women’s Hospital

Kei Ouchi

Kei Ouchi

“After emergency intubation, 33% of older adults die during the index hospitalisation,” said the researchers in the Journal of the American Geriatrics Society. “Only 24% of survivors are discharged to home.”

Lead study author Dr Kei Ouchi said: “A surprisingly large number of older patients who underwent intubation in the emergency department either died in the hospital or were discharged to a nursing home.”

Dr Ouchi said it was important that older patients, their families and clinicians made shared decisions about whether the individual should receive emergency intubation in future.

“It is difficult to make informed decisions on whether to provide intubation in older patients in an emergency situation, because this is a very stressful and emotional time,” he noted.

“Older patients, their families, and care providers are encouraged to make this decision before emergency situations requiring emergency department admission and intubation arise,” he added.

Brigham and Women's Hospital

Patient outcomes following emergency department intubation

Source: Kei Ouchi, Brigham and Women’s Hospital

The researchers found that in-hospital mortality following intubation was worse for patients over 90 than any other group, with 50 percent of those patients dying in the hospital following intubation, and 14% of these patients being discharged home. However, the outcomes were not drastically better for patients on the younger side of the study, with 29% patients between 65 and 74 dying in hospital following emergency intubation, and only 31% of these patients being discharged home.

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