ICU sedation, delirium & recovery
Prevalence, Timing, and Predictors of Patients Who Had New and/or Updated Goals of Care While in the ICU: A Multicenter Retrospective Study
Authors' conclusion
Almost 30% of patients had new- or updated-GOC documentation events while in ICU. Increasing age, higher SOFA scores, metastatic cancer, frailty, cardiac arrest, and ICU admission post-MET review predicted GOC changes while in ICU.
Study context
- Population
- All adults admitted to four ICUs, July 1 to December 31, 2023
- Participants
- 2,130 adults · 4 ICUs
- Exposure
- New-GOC vs Updated-GOC
- New-GOCn = 284
- Updated-GOCn = 346
- Outcome
- Prevalence, timing and predictors of new-GOC and updated-GOC documentation events after ICU admission
Methodological detailsmulticentre
- Multicentre
Main finding
As reported in the abstract
Prevalence and timing of GOC documentation events
| Group | Value | Time to event, median [IQR] |
|---|---|---|
| New-GOC | 13.3% | 18.3 [7.8-70.5] hr |
| Updated-GOC | 16.3% | 73.7 [22.7-157.8] hr |
Value
New-GOC13.3%
Updated-GOC16.3%
Time to event, median [IQR]
New-GOC18.3 [7.8-70.5] hr
Updated-GOC73.7 [22.7-157.8] hr
- Predictor of goals of care (GOC) documentation event: age
- OR = 1.02, 95% CI, 1.01-1.03
- Predictor: frailty
- OR = 1.30; 95% CI, 1.16-1.46
- Predictor: Sequential Organ Failure Assessment (SOFA)
- OR = 1.23, 95% CI, 1.17-1.29
- Predictor: metastatic cancer
- OR = 3.69, 95% CI, 2.17-6.26
- Predictor: ICU admission post medical emergency team review
- OR = 1.94, 95% CI, 1.40-2.69
- Predictor: cardiac arrest
- OR = 2.23, 95% CI, 1.22-4.06
- Predictor: pre-ICU GOC with selective treatment goals
- OR = 4.33, 95% CI, 3.18-5.90
- Predictor: pre-ICU GOC with comfort-based treatment goals
- OR = 7.66, 95% CI, 2.72-21.61
Observational data: associations, not effects.
Further findings
Predictors accounting for ICU mortality as a competing outcome
- Apart from SOFA, all other factors remained significantly associated with GOC documentation events
Original publication
Prevalence, Timing, and Predictors of Patients Who Had New and/or Updated Goals of Care While in the ICU: A Multicenter Retrospective Study. Crit Care Med. Published 31 March 2025. doi:10.
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