End-of-life practices in 282 intensive care units: data from the SAPS 3 database

Intensive Care Med. 2009 Apr;35(4):623-30. doi: 10.1007/s00134-008-1310-6. Epub 2008 Oct 10.


Objective: To report incidence and characteristics of decisions to forgo life-sustaining therapies (DFLSTs) in the 282 ICUs who contributed to the SAPS3 database.

Methods: We reviewed data on DFLSTs in 14,488 patients. Independent predictors of DFLSTs have been identified by stepwise logistic regression.

Results: DFLSTs occurred in 1,239 (8.6%) patients [677 (54.6%) withholding and 562 (45.4%) withdrawal decisions]. Hospital mortality was 21% (3,050/14,488); 36.2% (1,105) deaths occurred after DFLSTs. Across the participating ICUs, hospital mortality in patients with DFLSTs ranged from 80.3 to 95.4% and time from admission to decisions ranged from 2 to 4 days. Independent predictors of decisions to forgo LSTs included 13 variables associated with increased incidence of DFLSTs and 7 variables associated with decrease incidence of DFLST. Among hospital and ICU-related variables, a higher number of nurses per bed was associated with increased incidence of DFLST, while availability of an emergency department in the same hospital, presence of a full time ICU-specialist and doctors presence during nights and week-ends were associated with a decreased incidence of DFLST.

Conclusion: This large study identifies structural variables that are associated with substantial variations in the incidence and the characteristics of decisions to forgo life-sustaining therapies.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Asia
  • Australia
  • Cohort Studies
  • Data Collection / standards
  • Databases, Factual*
  • Decision Making, Organizational
  • Europe
  • Hospital Mortality / trends
  • Humans
  • Intensive Care Units / organization & administration*
  • International Cooperation
  • North America
  • Practice Patterns, Physicians' / organization & administration*
  • Prospective Studies
  • Software Design
  • Surveys and Questionnaires*
  • Terminal Care / organization & administration*
  • Withholding Treatment / statistics & numerical data