Sprung C L, Geber D, Eidelman L A, Baras M, Pizov R, Nimrod A, Oppenheim A, Epstein L, Cotev S
Department of Anesthesiology and Critical Care Medicine, Institute of Medicine, Ethics and Law, Hadassah University Medical Center, The Hebrew University of Jerusalem, Israel.
Crit Care Med. 1999 Jun;27(6):1073-9. doi: 10.1097/00003246-199906000-00021.
To assess physician decision-making in triage for intensive care and how judgments impact on patient survival.
Prospective, descriptive study.
General intensive care unit, university medical center.
All patients triaged for admission to a general intensive care unit were studied. Information was collected for the patient's age, diagnoses, surgical status, admission purpose, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and mortality. The number of available beds at the time of triage and reasons for refused admission were obtained.
Of 382 patients, 290 were admitted, 92 (24%) were refused admission, and 31 were admitted at a later time. Differences between admission diagnoses were found between patients admitted or not admitted (p < .001). Patients refused admission had higher APACHE II scores (15.6+/-1.5 admitted later and 15.8+/-1.4 never admitted) than did admitted patients (12.1+/-.4; p < .001). The frequency of admitting patients decreased when the intensive care unit was full (p < .001). Multivariate analysis revealed that triage to intensive care correlated with age, a full unit, surgical status, and diagnoses. Hospital mortality was lower in admitted (14%) than in refused patients (36% admitted later and 46% never admitted; p < .01) and in admitted patients with APACHE II scores of 11 to 20 (p = .02). The 28-day survival of patients was greater for admitted patients compared with patients never admitted (p = .01).
Physicians triage patients to intensive care based on the number of beds available, the admission diagnosis, severity of disease, age, and operative status. Admitting patients to intensive care is associated with a lower mortality rate, especially in patients with APACHE scores of 11 to 20.
评估医生在重症监护分诊中的决策过程以及这些判断如何影响患者的生存情况。
前瞻性描述性研究。
大学医学中心的综合重症监护病房。
对所有分诊进入综合重症监护病房的患者进行研究。收集患者的年龄、诊断结果、手术状态、入院目的、急性生理与慢性健康状况评估（APACHE）II评分及死亡率等信息。获取分诊时可用床位数量及拒绝入院原因。
382例患者中，290例被收治，92例（24%）被拒绝入院，31例随后被收治。收治和未收治患者的入院诊断存在差异（p <.001）。被拒绝入院的患者APACHE II评分（后来被收治的患者为15.6±1.5，从未被收治的患者为15.8±1.4）高于被收治患者（12.1±0.4；p <.001）。当重症监护病房满员时，收治患者的频率降低（p <.001）。多因素分析显示，重症监护分诊与年龄、病房满员情况、手术状态及诊断结果相关。被收治患者的医院死亡率（14%）低于被拒绝患者（后来被收治的患者为36%，从未被收治的患者为46%；p <.01），且APACHE II评分为11至20的被收治患者死亡率也较低（p = 0.02）。与从未被收治的患者相比，被收治患者的28天生存率更高（p = 0.01）。
医生根据可用床位数、入院诊断、疾病严重程度、年龄和手术状态对患者进行重症监护分诊。将患者收治入重症监护病房与较低的死亡率相关，尤其是APACHE评分为11至20的患者。
