Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa, USA.
Am J Crit Care. 2011 Sep;20(5):378-86. doi: 10.4037/ajcc2011827.
Many critically ill patients are transferred to other care facilities instead of to home at hospital discharge.
To identify patient-related factors associated with hospital discharge to a care facility after critical illness and to estimate the magnitude of risk associated with each factor.
Retrospective cohort study of 548 survivors of critical illness in a medical intensive care unit. Multivariable logistic regression was used to identify independent risk factors for discharge to a care facility. Only the first 72 hours of intensive care were analyzed.
Approximately one-quarter of the survivors of critical illness were discharged to a care facility instead of to home. This event occurred more commonly in older patients, even after adjustment for severity of illness and comorbid conditions (odds ratio [OR] 1.8 for patients ≥ 65 years of age vs patients < 65 years; 95% confidence interval [CI], 1.1-3.1; P = .02). The risk was greatest for patients who received mechanical ventilation (OR, 3.4; 95% CI, 2.0-5.8; P < .001) or had hospitalizations characterized by severe cognitive dysfunction (OR, 8.1; 95% CI, 1.3-50.6; P = .02) or poor strength and/or mobility (OR, 31.7; 95% CI, 6.4-157.3; P < .001). The model showed good discrimination (area under the curve, 0.82; 95% CI, 0.77-0.86).
The model, which did not include baseline function or social variables, provided good discrimination between patients discharged to a care facility after critical illness and patients discharged to home. These results suggest that future research should focus on the debilitating effects of respiratory failure and on conditions with cognitive and neuromuscular sequelae.
许多重症患者在出院时被转移到其他护理机构，而不是回家。
确定与重症后出院至护理机构相关的患者相关因素，并估计每个因素相关的风险程度。
对重症监护病房 548 例重症存活患者进行回顾性队列研究。多变量逻辑回归用于确定出院至护理机构的独立危险因素。仅分析重症监护的前 72 小时。
约四分之一的重症存活患者出院至护理机构，而不是回家。即使在调整了疾病严重程度和合并症后，年龄较大的患者更常见这种情况（≥65 岁的患者的比值比[OR]为 1.8，年龄 < 65 岁的患者；95%置信区间[CI]，1.1-3.1；P =.02）。接受机械通气的患者风险最高（OR，3.4；95% CI，2.0-5.8；P <.001），或存在严重认知功能障碍（OR，8.1；95% CI，1.3-50.6；P =.02）或虚弱和/或活动能力差（OR，31.7；95% CI，6.4-157.3；P <.001）的住院患者风险最大。该模型显示出良好的区分度（曲线下面积，0.82；95% CI，0.77-0.86）。
该模型未包括基线功能或社会变量，对重症后出院至护理机构的患者和出院至家庭的患者进行了良好的区分。这些结果表明，未来的研究应重点关注呼吸衰竭的致残影响以及认知和神经肌肉后遗症的情况。
