This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Amir Halevy, MD; Ryan C. Neal, MD; Baruch A. Brody, PhD

Arch Intern Med. 1996;156(1):100-104.

Abstract
Background
It is widely assumed that "futile" treatment consumes significant health care resources. This is a prospective cohort study.

Setting
The setting was the medical intensive care unit of Ben Taub General Hospital, a large public hospital in Houston, Tex.

Objective
To assess the frequency of intensive care unit patients meeting any of three broad definitions of futility.

Subjects
Subjects consisted of 129 consecutive patients admitted to the study intensive care unit during a 6-week period in the fall of 1993.

Main Outcome Measures
Operational definitions for three types of futility described in the literature were developed: Imminent demise futility, death imminent regardless of intervention, was assessed by using the APACHE II (Acute Physiology and Chronic Health Evaluation II) scoring system to determine the likelihood of mortality at more than the 90%, 95%, and 99% probabilities. Lethal condition futility, conditions incompatible with long-term survival, included five separate disease processes. Qualitative futility, conditions with an unacceptable quality of life, was assessed as a persistent vegetative state or as meeting criteria for poor prognosis due to a hypoxic ischemic coma.

Results
Only 2 bed-days (0.3%) were used by patients with more than 90% predicted mortality; 22 bed-days (3.6%) were used by patients with poor prognosis due to hypoxic ischemic coma; and 101 bed-days (16.4%) were used by patients satisfying criteria for the five lethal conditions.

Conclusions
The frequency of futile interventions appears to be low unless one is willing to accept a definition that includes patients who could survive for many months. If confirmed in other settings, this suggests that concepts of futility will not play a major role in cost containment.

(Arch Intern Med. 1996;156:100-104)

Author Affiliations
From the Department of Medicine (Drs Halevy, Neal, and Brody) and the Center for Ethics, Medicine, and Public Issues (Drs Halevy and Brody), Baylor College of Medicine, Houston, Tex.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Surrogate Decision-Makers' Perspectives on Discussing Prognosis in the Face of Uncertainty
Evans et al.
Am. J. Respir. Crit. Care Med. 2009;179:48-53.
ABSTRACT | FULL TEXT  

Futility: A Concept in Evolution
Burns and Truog
Chest 2007;132:1987-1993.
ABSTRACT | FULL TEXT  

Tackling Medical Futility in Texas
Truog
NEJM 2007;357:1-3.
FULL TEXT  

Do-Not-Resuscitate Orders and Medical Futility
Cantor et al.
Arch Intern Med 2003;163:2689-2694.
ABSTRACT | FULL TEXT  

Improving Family Communications at the End of Life: Implications for Length of Stay in the Intensive Care Unit and Resource Use
Ahrens et al.
Am J Crit Care 2003;12:317-324.
ABSTRACT | FULL TEXT  

Identifying futility in a paediatric critical care setting: a prospective observational study
Goh and Mok
Arch. Dis. Child. 2001;84:265-268.
ABSTRACT | FULL TEXT  

Avoiding Family Feuds: Responding to Surrogate Demands for Life-Sustaining Interventions
Bernard Lo
J Law Med Ethics 1999;27:74-80.
 

Physicians' Survival Predictions for Patients With Acute Congestive Heart Failure
Poses et al.
Arch Intern Med 1997;157:1001-1007.
ABSTRACT  

A Multi-institution Collaborative Policy on Medical Futility
Halevy and Brody
JAMA 1996;276:571-574.
ABSTRACT