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

Abstract Background Advances in pharmacologic therapy, non-invasive positive pressure ventilation (NIPPV) and advanced directives may have decreased the intubations of dyspneic elderly (≥65 years 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 ± 8 years; 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.