(427) Prevalence and Outcomes of Patients Who Had New and/or Updated Goals of Care in ICU

Introduction: Establishing timely patient-concordant Goals of Care (GOC) in ICU patients remains at the cornerstone of patient management ensuring that the chosen treatments align with the patient's goals and values. The patient’s clinical trajectory in ICU may result in a revised GOC. However, the rationale behind these changes is often unknown.

Methods: In this multicentre retrospective study, all adult patients admitted to ICU between 01/07/2023 to 31/12/2023 were included. We investigated the factors associated with a new/update in GOC using univariable logistic regression. We assessed the odds of in-hospital in these patients with new/updated GOC using a multivariable logistic regression, adjusting for, sex, acute illness severity (APACHE-III), and by hospital.

Results: 2,130 patients were included; new GOC in 13.4% (n=285) of patients and updated to an existing GOC documentation in 16.3% of patients. The median [IQR] time to GOC documentation in ICU was shorter for new when compared to updated GOC (18.3 [7.8-70.5] vs. (73.7 [22.7-157.8] hours). The predictors of GOC documentation included age (OR=1.04, 95%-CI: 1.03-1.05), APACHE-III (OR=1.05, 95%-C: 1.04-1.06), moderate-severe frailty (clinical frailty scale [6-8]; OR=4.14, 95%-CI: 2.90-5.91), presence of life-limiting illness (OR=2.80, 95%-CI: 2.09-3.74), chronic liver disease (OR=2.62, 95%-CI: 1.21-5.64) and metastatic cancer (OR=3.64, 95%-CI: 2.31-5.75). The odds of hospital mortality was higher for patients with updated GOC (adjusted OR=40.06, 95%-CI: 22.47-71.44) than new GOC(adjusted OR=9.50, 95%-CI: 4.85-18.59). Patients with new/updated GOC had longer ICU and hospital length of stay, more frequently had ICU complications (delirium and pressure injuries) and less frequently to be discharged home compared to patients without GOC.

Conclusions: We observed that almost 30% of the patients had a new and/or updated GOC in ICU.
The predictors of new and/or updated GOC documentation included increasing age, higher APACHE-III, comorbidities such as chronic liver disease and metastatic cancer, frailty status and presence of life-limiting illnesses. Finally, the odds of hospital mortality was higher for patients with updated GOC than new GOC.