Thirty-day survival rate of patients having a treatment withholding or treatment withdrawal decision in the emergency department: A retrospective monocentric study.

Abstract

Aim: Treatment withholding or withdrawal (TWW) is frequent in the emergency department (ED). Most studies on this topic only study patients who die in the ED. The main aim of this study was to determine 30-day mortality after a TWW decision in the ED, for patients discharged alive from ED.

Methods: This was a retrospective monocentric study conducted from January 1, 2020, to March 31, 2022, in a university hospital in France. Classes of TWW levels were low, medium and high, corresponding to do-not-resuscitate order, treatment withholding and treatment withdrawal, respectively. The secondary aim was to determine if there were predictive factors of survival among patients with medium-level TWW.

Results: Overall, 280 patients were included and 219 (78%) were analyzed, with mean age of 82 (±12) years. Respectively, 12 (5%), 145 (66%) and 62 (28%) had a low, medium, or high level of TWW. A total of 78 (36% [95% CI, 29%-42%]) patients were alive on day 30 following their ED admission: 7 (11%) with a high level, 63 (43%) with a medium level and 8 (67%) with a low level. No difference was found after adjustment between surviving and nonsurviving patients having a medium TWW level.

Conclusions: Among patients having a TWW decision in the ED, 36% of patients were alive at 30 days. The decision to limit some therapeutics for patients does not mean an imminent death, and those patients need adequate care. The care pathway for these patients must be organized accordingly. Geriatr Gerontol Int 2025; ••: ••-••.