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The New Zealand Medical Journal

 Journal of the New Zealand Medical Association, 11-June-2010, Vol 123 No 1316

[full text] [PDF]

Intensive care triage in Australia and New Zealand
Paul J Young, Richard Arnold

Abstract


Aim
To compare the attitudes towards common intensive care triage scenarios in New Zealand and Australia and to evaluate Australasian intensive care triage practice.

Method
A web-based survey of Australian and New Zealand intensive care doctors measuring demographics, details of recent triage decisions and attitudes towards various triage scenarios.

Results
A total of 238 responses were obtained (32.6% response rate). The mean number of triage decisions was 6.3 per clinician per week in New Zealand (95%CI 4.68.0) and 8.5 per week in Australia (95% CI 6.610.4) (test for difference in means, p=0.08). The mean rate of refusal for the week prior to the survey was 30.8% (95%CI 19.542.1) among New Zealand respondents and 25.1% (95% CI 19.730.4) among Australian respondents (test for difference in proportions, p=0.35). Australian respondents were more likely than New Zealand respondents to agree that it was appropriate to admit a patient:
- with a non-survivable brain injury who may progress to brain death (p=0.0001);
- with acute respiratory distress syndrome in the setting of relapsed acute myeloid leukaemia (p=0.0005);
- in a persistent vegetative state with pneumonia due to malposition of a feeding tube (p=0.03);
However, there were no differences found between Australian and New Zealand respondents on the appropriateness of admitting a patient:
- in a persistent vegetative state with pneumonia with a non-iatrogenic cause (p=0.58);
- with an infective exacerbation of chronic obstructive pulmonary disease with a background of functional impairment (p=0.060);
- of an advanced age who is unable to extubate due to drowsiness and hypoventilation following a laproscopic hernia repair (p=1.00);
- suffering from a massive stroke, intubated in a crowded emergency department, but now needing extubation and palliation (p=1.00).

Conclusions
New Zealand doctors have more selective views of what constitutes an appropriate admission to intensive care.

     
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