Multivariate analysis was performed using stepwise logistic regression models. A two-tailed P value < 0.05 was considered statistically significant. Statistical analyses were carried out using SPSS for Windows (SPSS, Inc., Chicago, IL, USA). Results Characteristics of MK-1775 supplier patients who died in the ED During the study period, among the 24 500 patients who were admitted to the ED, 14480 (59.1%) were

discharged home, 9758 (39.8) were transferred to other medical or surgical care units, and 85 (0.3%) were excluded. Analysis was therefore conducted on the remaining 177 patients. The mean age of the 177 patients who died on stretchers in the ED was 47 years (ranging from 16 to 83 years) with 100 males (56.5%), and Inhibitors,research,lifescience,medical 77 females (43.5%). Table ​Table11 shows the characteristics of these patients. The median APACHE II score was 17 ± 7.5 at admission, and 44.6% of the patients who died in the ED had chronic Inhibitors,research,lifescience,medical underlying disease. The most frequent presenting acute medical disorders were, cardiovascular (27.7%); infectious (17%), neurological (14.1%), and traumatic (14.1%). Table 1 Patient characteristics according to whether therapy Inhibitors,research,lifescience,medical was limited or

not (n = 177) Characteristics of patients with WH/WD decisions A decision to withhold or withdraw life support was taken for 54 patients (30.5%), thus 123 patients died without level-of-care limitation. Withholding concerned 43 patients (24.2%), and withdrawal concerned 11 patients (6.2%) (Figure ​(Figure11). Figure 1 Trial profile of 24,500 patients admitted to emergency departments during Inhibitors,research,lifescience,medical study period. Patients who died as a result of withholding and withdrawal of life-sustaining treatment had a median age of 57.7 ± 17 years, of whom 30 (55.5%) were men. The median APACHE II score

at admission was 20.3 ± 7.2. The most common chronic underlying diseases were heart failure (14.1%), and malignancy (27.7%), and the most common reasons for admission to the ED among these patients were neurological (14.1%), and cardiovascular diseases (27.7%). Median (IQR) time interval between ED admission Inhibitors,research,lifescience,medical and a decision to withhold or to withdraw life-support therapies were respectively of 7 h (IQR: 2-24 h), and 12 h (IQR: 6-24 h). Median (IQR) time interval between a TCL decision to withhold or to withdraw life-support therapies and death were respectively of 24 h (IQR: 12-48 h), and 12 h (IQR: 12-76 h). Criteria used to justify limiting life-support therapies for patients who died in ED were reported in table ​table2.2. The decision to limit life-support procedures was recorded in the medical file for only one patient. Life-sustaining treatment modalities withheld or withdrawn are shown in Table ​Table3.3. The most common modalities withheld or withdrawn life-support therapy were mechanical ventilation in 30 cases (17%), vasopressor and inotrops infusion in 28 cases (15.8%).