| Title |
Withholding or withdrawal of treatment under French rules: a study performed in 43 intensive care units
|
|---|---|
| Published in |
Annals of Intensive Care, June 2015
|
| DOI | 10.1186/s13613-015-0056-x |
| Pubmed ID | |
| Authors |
Olivier Lesieur, Maxime Leloup, Frédéric Gonzalez, Marie-France Mamzer, EPILAT study group |
| Abstract |
In France, decisions to limit treatment fall under the Leonetti law adopted in 2005. Leading figures from the French world of politics, science, and justice recently claimed for amendments to the law, considering it incomplete. This study, conducted before any legislative change, aimed to investigate the procedural aspects of withholding/withdrawing treatment in French ICUs and their adequacy with the existing law. The characteristics of patients qualified for a withholding/withdrawal procedure were prospectively collected in 43 French ICUs. The study period (60 or 90 days under normal operating conditions) took place in the first half of 2013. During the study period, 777 (14 %) of 5589 admitted patients and 584 (52 %) of 1132 patients dying in the ICU had their treatment withheld or withdrawn. Whereas 344 patients had treatment(s) withheld (i.e., not started or not increased if already engaged), 433 had one or more treatment(s) withdrawn. Withdrawal of treatment was applied in 156 of 223 (70 %) brain-injured patients, compared to 277 of 554 (50 %) patients with other reasons for admission (p < 0.01). At the time of the decision-making, the patient's wishes were known in 181 (23 %) of the 777 cases in one or more different way(s): 73 (9.4 %) from the patient, 10 (1.3 %) by advance directives, 10 (1.3 %) through a designated trusted person, and 108 (13.9 %) reported by the family or close relatives. An external consultant was involved in less than half of all decisions (356 of 777, 46 %). Of the 777 patients qualified for a withholding/withdrawal procedure, 133 (17 %) were discharged alive from the hospital (126 after withholding, 7 after withdrawal). More than half of deaths in the study population occurred after a decision to withhold or withdraw treatment. Among patients under withholding/withdrawal procedures, brain-injured subjects were more likely to undergo a withdrawal procedure. The prevalence of advance directives and designated trusted persons was low. Because patients' preferences were unknown in more than three quarters of cases, decisions remained primarily based on medical judgment. Limitations, especially withholding of treatment, did not preclude survival and hospital discharge. |
X Demographics
The data shown below were collected from the profiles of 24 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United Kingdom | 3 | 13% |
| Spain | 2 | 8% |
| Sweden | 1 | 4% |
| Norway | 1 | 4% |
| Slovenia | 1 | 4% |
| United States | 1 | 4% |
| Malaysia | 1 | 4% |
| Unknown | 14 | 58% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 16 | 67% |
| Practitioners (doctors, other healthcare professionals) | 7 | 29% |
| Scientists | 1 | 4% |
Mendeley readers
The data shown below were compiled from readership statistics for 74 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United States | 1 | 1% |
| Unknown | 73 | 99% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Researcher | 12 | 16% |
| Student > Master | 9 | 12% |
| Student > Postgraduate | 7 | 9% |
| Student > Doctoral Student | 7 | 9% |
| Student > Bachelor | 6 | 8% |
| Other | 18 | 24% |
| Unknown | 15 | 20% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 37 | 50% |
| Nursing and Health Professions | 10 | 14% |
| Agricultural and Biological Sciences | 2 | 3% |
| Social Sciences | 2 | 3% |
| Earth and Planetary Sciences | 1 | 1% |
| Other | 3 | 4% |
| Unknown | 19 | 26% |
Attention Score in Context
This research output has an Altmetric Attention Score of 23. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 23 May 2023.
All research outputs
#1,607,729
of 25,287,709 outputs
Outputs from Annals of Intensive Care
#187
of 1,180 outputs
Outputs of similar age
#19,431
of 271,081 outputs
Outputs of similar age from Annals of Intensive Care
#3
of 11 outputs
Altmetric has tracked 25,287,709 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 93rd percentile: it's in the top 10% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 1,180 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 18.3. This one has done well, scoring higher than 84% of its peers.
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We're also able to compare this research output to 11 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 81% of its contemporaries.