Deaths in critical care and hospice - prevalence, trends, influences: a national decedent cohort study

Jonathan Mayes, Stela McLachlan, Emma Carduff, Joanne McPeake, Kirsty Boyd, Natalie Pattison, Nazir I Lone*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives
End-of-life and bereavement care support services differ in critical care and inpatient hospice settings. There is limited population-level data comparing deaths in these two locations. We aimed to compare characteristics of people who die in critical care units and in hospices, identify factors associated with place of death, and report 12-year trends in Scotland.
Methods
We undertook a cohort study of decedents aged ≥16 years in Scotland (2005-2017). Location of death was identified from linkage to the Scottish Intensive Care Society Audit Group database and NRS Death Records. We developed a multinomial logistic regression model to identify factors independently associated with location of death.
Results
There were 710,829 deaths in Scotland, of which 36,316 (5.1%) occurred in critical care units and 42,988 (6.1%) in hospices. As a proportion of acute hospital deaths, critical care deaths increased from 8.0% to 11.2%. Approximately 1 in 8 deaths in those aged under 40 years occurred in critical care. Factors independently associated with hospice death included living in less deprived areas, cancer as the cause of death, and presence of comorbidities. In contrast, liver disease and accidents as the cause of death and absence of comorbidities were associated with death in critical care.
Conclusions
Similar proportions of deaths in Scotland occur in critical care units and hospices. Given the younger age profile and unexpected nature of deaths occurring in critical care units, there is a need for a specific focus on end-of-life and bereavement support services in critical care units.
Original languageEnglish
JournalBMJ Supportive & Palliative Care
DOIs
Publication statusPublished - 11 Aug 2021

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