Background In France, a significant proportion of end-of-life (EOL) decisions occur in emergency departments (EDs), where time constraints and limited resources may hinder optimal care. Although withholding or withdrawing life-sustaining treatments (WHWD) is common in this context, the impact of timing on patient outcomes remains unclear.

Objective:

To assess how the timing of WHWD decisions influences short- and long-term outcomes among ED patients.

Methods:

We conducted a retrospective, observational study at Beaujon Hospital's ED (Paris, France) between January 2020 and December 2021. We included 354 adult patients admitted to the observation unit with a WHWD decision. Patients were categorized into early (eWHWD) and late (lWHWD) groups based on the median time to decision. The primary endpoint was 28-day all-cause mortality. Cox regression was used for survival analysis, adjusting for age, sex, comorbidities, functional status, and severity of illness.

Inclusion Criteria:

• To be included, patients hospitalised after their ED visit must be admitted to the observation unit (OU) in association with a mention of a withholding/withdrawing of the life-sustaining treatment in the ED medical record.

Exclusion Criteria:

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Adult patients in end of life situation with withholding or withdrawing decision