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Background <p>In France, a significant proportion of end-of-life (EOL) decisions occur in emergency departments (EDs), where time constraints and limited resources may hinder optimal care. Although withholding or withdrawing life-sustaining treatments (WHWD) is common in this context, the impact of timing on patient outcomes remains unclear. The aim of this study was to assess the effect of WHWD decision timing on short- and long-term outcomes among adult emergency department patients.</p> Methods <p>We conducted a retrospective, observational study at Beaujon Hospital’s ED (Paris, France) between January 2020 and December 2021. We included all adult patients admitted to the observation unit with a WHWD decision. Patients were categorized into early (eWHWD) and late (lWHWD) groups based on the median time to decision. The primary endpoint was 28-day all-cause mortality. Cox regression was used for survival analysis, adjusting for age, sex, comorbidities, functional status, and severity of illness.</p> Results <p>WHWD was decided in 354 patients. Patients in the eWHWD group (<i>n</i> = 176) were older, more functionally impaired, and had higher illness severity than those in the lWHWD group (<i>n</i> = 178). Early decisions occurred within a median of 2&#xa0;h versus 7&#xa0;h in the late group. Short-term mortality was significantly higher in the eWHWD group at 7 days (58% vs. 44%) and 28 days (76% vs. 65%). After adjustment, late WHWD remained independently associated with better survival at 7-days, 28-days, 90-days and 1-year. Respectively adjusted Hazard Ratios were equal to 0.71; 95% confidence interval (CI) (0.66 to 0.76), 0.73; 95% CI (0.68 to 0.78), 0.76; 95% CI (0.72 to 0.81) and 0.86; 95% CI (0.81 to 0.91).</p> Conclusion <p>Early WHWD decisions reflect more severe patient conditions and are linked to poorer short and long-term outcomes. Enhancing advance care planning and integrating palliative care into ED practices may improve decision quality and align care with patient values.</p>

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Early decision effect of withholding and/or withdrawing life-sustaining treatment on emergency department patients’ short- and long-term outcomes: a retrospective analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月7日

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  • Joseph Sinoquet,
  • Pradeebane Vaittinada Ayar,
  • Prabakar Vaittinada Ayar

摘要

Background

In France, a significant proportion of end-of-life (EOL) decisions occur in emergency departments (EDs), where time constraints and limited resources may hinder optimal care. Although withholding or withdrawing life-sustaining treatments (WHWD) is common in this context, the impact of timing on patient outcomes remains unclear. The aim of this study was to assess the effect of WHWD decision timing on short- and long-term outcomes among adult emergency department patients.

Methods

We conducted a retrospective, observational study at Beaujon Hospital’s ED (Paris, France) between January 2020 and December 2021. We included all adult patients admitted to the observation unit with a WHWD decision. Patients were categorized into early (eWHWD) and late (lWHWD) groups based on the median time to decision. The primary endpoint was 28-day all-cause mortality. Cox regression was used for survival analysis, adjusting for age, sex, comorbidities, functional status, and severity of illness.

Results

WHWD was decided in 354 patients. Patients in the eWHWD group (n = 176) were older, more functionally impaired, and had higher illness severity than those in the lWHWD group (n = 178). Early decisions occurred within a median of 2 h versus 7 h in the late group. Short-term mortality was significantly higher in the eWHWD group at 7 days (58% vs. 44%) and 28 days (76% vs. 65%). After adjustment, late WHWD remained independently associated with better survival at 7-days, 28-days, 90-days and 1-year. Respectively adjusted Hazard Ratios were equal to 0.71; 95% confidence interval (CI) (0.66 to 0.76), 0.73; 95% CI (0.68 to 0.78), 0.76; 95% CI (0.72 to 0.81) and 0.86; 95% CI (0.81 to 0.91).

Conclusion

Early WHWD decisions reflect more severe patient conditions and are linked to poorer short and long-term outcomes. Enhancing advance care planning and integrating palliative care into ED practices may improve decision quality and align care with patient values.