Azoulay E, Pochard F, Chevret S, Vinsonneau C, Garrouste M, Cohen Y, Thuong M, Paugam C, Apperre C, De Cagny B, Brun F, Bornstain C, Parrot A, Thamion F, Lacherade J C, Bouffard Y, Le Gall J R, Herve C, Grassin M, Zittoun R, Schlemmer B, Dhainaut J F
Intensive Care and Biostatistics Departments, Saint-Louis Teaching Hospital and Paris VII Teaching, Paris, France.
Crit Care Med. 2001 Nov;29(11):2132-6. doi: 10.1097/00003246-200111000-00014.
Recommendations for triage to intensive care units (ICUs) have been issued but not evaluated.
In this prospective, multicenter study, all patients granted or refused admission to 26 ICUs affiliated with the French Society for Critical Care were included during a 1-month period. Characteristics of participating ICUs and patients, circumstances of triage, and description of the triage decision with particular attention to compliance with published recommendations were recorded.
During the study period, 1,009 patients were and 283 were not admitted to the participating ICUs. Refused patients were more likely to be older than 65 yrs (odds ratio [OR], 3.53; confidence interval [CI], 1.98-5.32) and to have a poor chronic health status (OR, 3.09; CI, 2.05-4.67). An admission diagnosis of acute respiratory or renal failure, shock, or coma was associated with admission, whereas chronic severe respiratory and heart failure or metastatic disease without hope of remission were associated with refusal (OR, 2.24; CI, 1.38-3.64). Only four (range, 0-8) of the 20 recommendations for triage to ICU were observed; a full unit and triage over the phone were associated with significantly poorer compliance with recommendations (0 [0-2] vs. 6 [2-9], p =.0003; and 1 [0-6] vs. 6 [1-9], p <.0001; respectively).
Recommendations for triage to intensive care are rarely observed, particularly when the unit is full or triage is done over the phone. These recommendations may need to be redesigned to improve their practicability under real-life conditions, with special attention to phone triage and triaging to a full unit.
已发布了关于分诊至重症监护病房（ICU）的建议，但尚未进行评估。
在这项前瞻性多中心研究中，纳入了在1个月期间被法国重症监护学会下属的26个ICU收治或拒绝收治的所有患者。记录了参与研究的ICU和患者的特征、分诊情况，以及分诊决策的描述，尤其关注对已发布建议的遵循情况。
在研究期间，1009例患者被参与研究的ICU收治，283例未被收治。被拒绝收治的患者更可能年龄大于65岁（比值比[OR]，3.53；置信区间[CI]，1.98 - 5.32）且慢性健康状况较差（OR，3.09；CI，2.05 - 4.67）。急性呼吸或肾衰竭、休克或昏迷的入院诊断与收治相关，而慢性重度呼吸和心力衰竭或无法缓解的转移性疾病与拒绝收治相关（OR，2.24；CI，1.38 - 3.64）。在20条分诊至ICU的建议中，仅观察到4条（范围为0 - 8条）；病房满员和电话分诊与对建议的遵循情况显著较差相关（分别为0[0 - 2]对6[2 - 9]，p = 0.0003；以及1[0 - 6]对6[1 - 9]，p < 0.0001）。
分诊至重症监护的建议很少被遵循，尤其是在病房满员或通过电话进行分诊时。可能需要重新设计这些建议，以提高其在现实生活条件下的实用性，尤其要关注电话分诊和分诊至满员病房的情况。
