Orsini Jose, Butala Ashvin, Ahmad Noeen, Llosa Alfonso, Prajapati Ramesh, Fishkin Edward
Department of Medicine, New York University School of Medicine at Woodhull Medical and Mental Health Center, 760 Broadway, Brooklyn, NY 11206, USA.
J Clin Med Res. 2013 Oct;5(5):343-9. doi: 10.4021/jocmr1501w. Epub 2013 Aug 5.
Few data is available on triage of critically ill patients. Because the demand for ICU beds often exceeds their availability, frequently intensivists need to triage these patients in order to equally and efficiently distribute the available resources based on the concept of potential benefit and reasonable chance of recovery. The objective of this study is to evaluate factors influencing triage decisions among patients referred for ICU admission and to assess its impact in outcome.
A single-center, prospective, observational study of 165 consecutive triage evaluations was conducted in patients referred for ICU admission that were either accepted, or refused and treated on the medical or surgical wards as well as the step-down and telemetry units.
Seventy-one patients (43.0%) were accepted for ICU admission. Mean Acute Physiology and Chronic Health Evaluation (APACHE)-II score was 15.3 (0 - 36) and 13.9 (0 - 30) for accepted and refused patients, respectively. Three patients (4.2%) had active advance directives on admission to ICU. Age, gender, and number of ICU beds available at the time of evaluation were not associated with triage decisions. Thirteen patients (18.3%) died in ICU, while the in-hospital mortality for refused patients was 12.8%.
Refusal of admission to ICU is common, although patients in which ICU admission is granted have higher mortality. Presence of active advance directives seems to play an important role in the triage decision process. Further efforts are needed to define which patients are most likely to benefit from ICU admission. Triage protocols or guidelines to promote efficient critical care beds use are warranted.
关于重症患者分诊的数据很少。由于重症监护病房（ICU）床位的需求常常超过其可提供数量，重症医学专家经常需要对这些患者进行分诊，以便基于潜在获益和合理康复机会的概念，公平且高效地分配可用资源。本研究的目的是评估影响转诊至ICU患者分诊决策的因素，并评估其对预后的影响。
对165例连续转诊至ICU的患者进行了单中心、前瞻性观察性研究，这些患者要么被收入ICU，要么被拒绝并在内科或外科病房以及降级护理病房和遥测病房接受治疗。
71例患者（43.0%）被收入ICU。收入ICU和被拒绝的患者急性生理与慢性健康状况评分系统（APACHE）-II的平均分分别为15.3（0 - 36）和13.9（0 - 30）。3例患者（4.2%）在入住ICU时有有效的预立医疗指示。年龄、性别以及评估时可用的ICU床位数与分诊决策无关。13例患者（18.3%）在ICU死亡，而被拒绝患者的院内死亡率为12.8%。
拒绝收入ICU的情况很常见，尽管被收入ICU的患者死亡率更高。有效的预立医疗指示似乎在分诊决策过程中起重要作用。需要进一步努力确定哪些患者最有可能从入住ICU中获益。有必要制定分诊方案或指南以促进ICU床位的高效使用。
