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

<bold>Background: </bold>Advances in pharmacologic therapy, non-invasive positive pressure ventilation (NIPPV) and advanced directives may have decreased the intubations of dyspneic elderly (≥65years old) patients in the emergency department (ED).<bold>Objective: </bold>To determine if the percentage of elderly ED patients intubated has decreased in recent years.<bold>Methods: </bold>Design: Retrospective multihospital cohort.<bold>Setting: </bold>Consecutive ED patients in nine NJ hospitals (1/1/1999 to 9/30/2014).<bold>Protocol: </bold>We identified patients intubated in the ED by CPT codes.<bold>Data Analysis: </bold>We calculated the annual percentage of patients ≥65 intubated and the percentage intubated by diagnosis along with 95% confidence intervals (CIs).<bold>Results: </bold>Of the 5,693,380 total patients in the database there were 1,065,371 visits for patients≥65. Their average age was 80±8years; 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%).<bold>Conclusion: </bold>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. [ABSTRACT FROM AUTHOR]