Snyder John E, Loschner A Lukas, Kepley Hayden O
University of North Carolina at Chapel Hill School of Medicine, South East Area Health Education Center (SEAHEC) Department of Internal Medicine, USA.
N C Med J. 2010 May-Jun;71(3):199-205.
When health care practitioners assist patients with decisions about advance directives, the risks and benefits of resuscitation options are often discussed. Whether practitioners have accurate perceptions about in-hospital resuscitation success rates is not known, nor is the effect of patient age on these perceptions. Age on its own has not been definitively associated with decreased inpatient survival after resuscitation. The goal of this study was to compare perceived resuscitation success rates with the actual observed rates at our hospital and to assess the effect of patient age on the perceived rates.
A survey-based observational study of on-duty hospital-based faculty, internal medicine resident physicians, and critical care nurses was performed over a week-long recruitment period to estimate their perception of in-hospital resuscitation success rates for patients of different ages. The survey response rate was 100%.
Patient survival to hospital discharge following in-hospital resuscitation during a three-year period at New Hanover Regional Medical Center was 29.22% for patients < 70 years old and 20.13% for patients > or = 70. The perceived in-hospital resuscitation success rates were 38.76% for patients < 70 and 21.24% for patients > or = 70. This corresponds to a statistically significant overestimation of resuscitation success rates for patients < 70 years old (p < 0.001), although predictions were fairly accurate for patients > or = 70. When posed with one of two clinical scenarios where the only different variable was patient age, participants were statistically more likely to predict success for the younger patient. Subgroup analysis showed general agreement in the estimates between the three major types of practitioners, and factors such as length of experience in their current position and time since their last Advanced Cardiac Life Support (ACLS) recertification course did not have a significant impact on these perceptions.
Practitioners may overestimate resuscitation success rates in patients younger than 70. Disseminating information about ACLS success rates to clinicians, and what factors affect or do not affect these rates, seems essential.
当医疗从业者协助患者做出关于预立医疗指示的决策时，常常会讨论复苏选项的风险和益处。目前尚不清楚从业者对院内复苏成功率的认知是否准确，也不清楚患者年龄对这些认知的影响。年龄本身与复苏后住院患者生存率降低并无明确关联。本研究的目的是比较我院感知到的复苏成功率与实际观察到的成功率，并评估患者年龄对感知成功率的影响。
在为期一周的招募期内，对医院在职教职员工、内科住院医师和重症监护护士进行了一项基于调查的观察性研究，以估计他们对不同年龄患者院内复苏成功率的认知。调查回复率为100%。
在新汉诺威地区医疗中心为期三年的时间里，年龄<70岁的患者院内复苏后存活至出院的比例为29.22%，年龄≥70岁的患者为20.13%。感知到的院内复苏成功率，年龄<70岁的患者为38.76%，年龄≥70岁的患者为21.24%。这对应于年龄<70岁患者的复苏成功率在统计学上被显著高估（p<0.001），尽管对年龄≥70岁的患者预测相当准确。当面对两种临床情景之一，其中唯一不同的变量是患者年龄时，参与者在统计学上更有可能预测年轻患者复苏成功。亚组分析表明，三类主要从业者的估计总体一致，诸如在当前职位的工作年限以及自上次高级心血管生命支持（ACLS）再认证课程以来的时间等因素，对这些认知没有显著影响。
从业者可能高估了70岁以下患者的复苏成功率。向临床医生传播关于ACLS成功率的信息以及哪些因素影响或不影响这些成功率似乎至关重要。
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