Intubations in elderly patients have decreased from 1999 through 2014-Results of a multi-center cohort study.

BACKGROUND

Advances in pharmacologic therapy, non-invasive positive pressure ventilation (NIPPV) and advanced directives may have decreased the intubations of dyspneic elderly (≥65years old) patients in the emergency department (ED).

OBJECTIVE

To determine if the percentage of elderly ED patients intubated has decreased in recent years.

METHODS

Design

Retrospective multihospital cohort.

SETTING

Consecutive ED patients in nine NJ hospitals (1/1/1999 to 9/30/2014).

PROTOCOL: We identified patients intubated in the ED by CPT codes.

DATA ANALYSIS: We calculated the annual percentage of patients ≥65 intubated and the percentage intubated by diagnosis along with 95% confidence intervals (CIs).

RESULTS

Of the 5,693,380 total patients in the database there were 1,065,371 visits for patients≥65. Their average age was 80±8years; 54% were female. Of these, 6297 were intubated (0.59%). From 1999 to 2014 the percent intubated decreased from 0.73% to 0.52%, a relative decrease of 29% (95% CI: 17%, 38%). The specific diagnoses with >500 intubations were congestive heart failure (CHF), pneumonia and cardiac arrest, accounting for 37% of the total. Of these three, CHF was the only diagnosis with a statistically significant change from 1999 to 2014: a relative decrease of 70% (95% CI: 53%, 81%). If all diagnoses without CHF are analyzed the overall relative decrease is 14% (95% CI: 3%, 24%).

CONCLUSION

Intubation rates for patients≥65 decreased from 1999 through 2014, particularly in CHF patients. We speculate that these findings reflect wider implementation of NIPPV, other therapeutic modalities and advanced directives.