Observational studyBMC palliative care2021
Advanced care planning during the COVID-19 pandemic: ceiling of care decisions and their implications for observational data.
Observational study in BMC palliative care, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 16 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Ceiling of Care in Acute Care Settings: A Concept Analysis.Journal of nursing management · 2026Pooled it
- Nationwide analysis of mortality predictors following in-hospital cardiac arrest in older Thai adults, 2016-2024.Resuscitation plus · 2026Article
- Impact of ceiling of care on mortality across four COVID-19 epidemic waves in Catalonia: a multicentre prospective cohort study.BMJ open · 2025Article
- Development and validation of a model to predict ceiling of care in COVID-19 hospitalized patients.BMC palliative care · 2024Article
- Cardio pulmonary resuscitation (CPR) in the frail and those with multiple health conditions: Outcomes before and during the COVID pandemic.Clinical medicine (London, England) · 2024Article
- Frailty in Critically Ill Patients with COVID-19: The Lessons Learned.Advances in experimental medicine and biology · 2024Review
- Comparison of different prognostic scores in estimating short- and long-term mortality in COVID-19 patients above 60 years old in a university hospital in Belgium.European geriatric medicine · 2023Observational
- Code status orders in hospitalized patients with COVID-19.Resuscitation plus · 2023Article
- Japanese Local Governments' Dissemination Activities for Advance Care Planning: A Descriptive Analysis of a Nationwide Survey during the COVID-19 Pandemic.International journal of environmental research and public health · 2023Article
- Characteristics and Outcomes by Ceiling of Care of Subjects Hospitalized with COVID-19 During Four Waves of the Pandemic in a Metropolitan Area: A Multicenter Cohort Study.Infectious diseases and therapy · 2023Article
- Correction: Advanced care planning during the COVID-19 pandemic: ceiling of care decisions and their implications for observational data.BMC palliative care · 2022Article
- Impact of frailty on clinical outcomes in patients with and without COVID-19 pneumonitis admitted to intensive care units in Australia and New Zealand: a retrospective registry data analysis.Critical care (London, England) · 2022Article
- Clinical Frailty Scale (CFS) indicated frailty is associated with increased in-hospital and 30-day mortality in COVID-19 patients: a systematic review and meta-analysis.Annals of intensive care · 2022Article
- Parkinson's disease and Covid-19: Is there an impact of ethnicity and the need for palliative care.International review of neurobiology · 2022Article
- Article
- Implementation of advance care planning amid the COVID-19 crisis: A narrative review and synthesis.Geriatrics & gerontology international · 2021Review
Corrections and comments
- Erratum issued
Authors and funding
16 authors.
Funding
Abstract
backgroundObservational studies investigating risk factors in coronavirus disease 2019 (COVID-19) have not considered the confounding effects of advanced care planning, such that a valid picture of risk for elderly, frail and multi-morbid patients is unknown. We aimed to report ceiling of care and cardiopulmonary resuscitation (CPR) decisions and their association with demographic and clinical characteristics as well as outcomes during the COVID-19 pandemic.
methodsRetrospective, observational study conducted between 5th March and 7th May 2020 of all hospitalised patients with COVID-19. Ceiling of care and CPR decisions were documented using the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process. Unadjusted and multivariable regression analyses were used to determine factors associated with ceiling of care decisions and death during hospitalisation.
resultsA total of 485 patients were included, of whom 409 (84·3%) had a documented ceiling of care; level one for 208 (50·9%), level two for 75 (18·3%) and level three for 126 (30·8%). CPR decisions were documented for 451 (93·0%) of whom 336 (74·5%) were 'not for resuscitation'. Advanced age, frailty, White-European ethnicity, a diagnosis of any co-morbidity and receipt of cardiovascular medications were associated with ceiling of care decisions. In a multivariable model only advanced age (odds 0·89, 0·86-0·93 p < 0·001), frailty (odds 0·48, 0·38-0·60, p < 0·001) and the cumulative number of co-morbidities (odds 0·72, 0·52-1·0, p = 0·048) were independently associated. Death during hospitalisation was independently associated with age, frailty and requirement for level two or three care.
conclusionCeiling of care decisions were made for the majority of patients during the COVID-19 pandemic, broadly in line with known predictors of poor outcomes in COVID-19, but with a focus on co-morbidities suggesting ICU admission might not be a reliable end-point for observational studies where advanced care planning is routine.
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