Early decision effect of withholding and/or withdrawing life-sustaining treatment on emergency department patients’ short- and long-term outcomes: a retrospective analysis
Abstract
BackgroundIn 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 lifesustaining 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.
MethodsWe 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 longterm outcomes. Enhancing advance care planning and integrating palliative care into ED practices may improve decision quality and align care with patient values.
Related
- An Electron Relay Driven by Built‐in Electric Fields for Self‐Sustaining and External‐Energy‐Free Fenton‐Like Catalysis
- From Outpatient Consumption to Receiving Waters: A Retrospective Screening Assessment of Antibiotic Loads, Resistance Indicators, and Implications for the Recast Urban Wastewater Treatment Directive.
- Construction of a Daphnia -sustaining microcosm using purely inorganic medium: a system designed to investigate endogenous nutrient biosynthesis
- Understanding, expanding and sustaining UK treescapes: People, place and nature in a changing world
- CHEILOSIA INSIGNIS, NEW FOR VAR DEPARTMENT (FRANCE) (DIPTERA, SYRPHIDAE)
BibTeX
@article{sinoquet2026early,
title = {{Early decision effect of withholding and/or withdrawing life-sustaining treatment on emergency department patients’ short- and long-term outcomes: a retrospective analysis}},
author = {Joseph Sinoquet and Pradeebane Vaittinada Ayar and Prabakar Vaittinada Ayar},
journal = {BMC Emergency Medicine},
year = {2026},
month = jul,
doi = {10.1186/s12873-026-01669-7},
url = {https://hal.science/hal-05820663v1},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Early decision effect of withholding and/or withdrawing life-sustaining treatment on emergency department patients’ short- and long-term outcomes: a retrospective analysis
AU - Joseph Sinoquet
AU - Pradeebane Vaittinada Ayar
AU - Prabakar Vaittinada Ayar
PY - 2026
DA - 2026/07/07
JO - BMC Emergency Medicine
DO - 10.1186/s12873-026-01669-7
UR - https://hal.science/hal-05820663v1
AB - BackgroundIn 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 lifesustaining 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. MethodsWe 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 longterm outcomes. Enhancing advance care planning and integrating palliative care into ED practices may improve decision quality and align care with patient values.
SN - 1471-227X
ER -