Shin Seong Hoon, Hui David, Chisholm Gary B, Kwon Jung Hye, San-Miguel Maria Teresa, Allo Julio A, Yennurajalingam Sriram, Frisbee-Hume Susan E, Bruera Eduardo
Department of Palliative Care and Rehabilitation Medicine, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
Department of Palliative Care and Rehabilitation Medicine, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
J Pain Symptom Manage. 2014 Jun;47(6):1028-34. doi: 10.1016/j.jpainsymman.2013.07.015. Epub 2013 Nov 15.
Most patients admitted to acute palliative care units (APCUs) are transferred from inpatient oncology units. We hypothesized that patients admitted to APCUs from emergency centers (ECs) have symptom burdens and outcomes that differ from those of transferred inpatients.
The purpose of this retrospective cohort study was to compare the symptom burdens and survival rate of patients admitted to an APCU from an EC with those of inpatients transferred to the APCU.
Among the 2568 patients admitted to our APCU between September 1, 2003 and August 31, 2008, 312 (12%) were EC patients. We randomly selected 300 inpatients transferred to the APCU as controls (The outcome data were unavailable for two patients). We retrieved data on patient demographics, cancer diagnosis, Edmonton Symptom Assessment System scores, discharge outcomes, and overall survival from time of admission to the APCU.
The EC patients had higher rates of pain, fatigue, nausea, and insomnia and were less likely to be delirious. They were more than twice as likely to be discharged alive than transferred inpatients. Kaplan-Meier plot tests for product-limit survival estimate from admission to APCU for EC patients and inpatients were statistically significant (median survival 34 vs. 31 days, P<0.0001). In multivariate analysis, EC admission (odds ratio [OR]=1.8593, 95% confidence interval [CI] 1.1532-2.9961), dyspnea (OR=0.8533, 95% CI 0.7892-0.9211), well-being (OR=1.1192, 95% CI 1.0234-1.2257), and delirium (OR=0.3942, 95% CI 0.2443-0.6351) were independently associated with being discharged alive.
The EC patients have a higher acute symptom burden and are more likely to be discharged alive than transferred inpatients. The APCU was successful at managing symptoms and facilitating the discharge of both inpatients and EC patients to the community although the patients had severe symptoms on admission.
大多数入住急性姑息治疗病房（APCU）的患者是从肿瘤住院病房转来的。我们推测，从急诊中心（EC）转入APCU的患者的症状负担和结局与转入的住院患者不同。
这项回顾性队列研究的目的是比较从急诊中心转入APCU的患者与转入APCU的住院患者的症状负担和生存率。
在2003年9月1日至2008年8月31日期间入住我们APCU的2568例患者中，312例（12%）是急诊中心患者。我们随机选择300例转入APCU的住院患者作为对照（两名患者的结局数据不可用）。我们检索了患者人口统计学、癌症诊断、埃德蒙顿症状评估系统评分、出院结局以及从入住APCU到死亡的总生存期等数据。
急诊中心患者的疼痛、疲劳、恶心和失眠发生率较高，谵妄的可能性较小。他们存活出院的可能性是转入的住院患者的两倍多。急诊中心患者和住院患者从入住APCU到死亡的累积生存率的Kaplan-Meier曲线检验具有统计学意义（中位生存期分别为34天和31天，P<0.0001）。在多变量分析中，急诊中心入院（比值比[OR]=1.8593，95%置信区间[CI]1.1532-2.9961）、呼吸困难（OR=0.8533，95%CI 0.7892-0.9211）、健康状况（OR=1.1192，95%CI 1.0234-1.2257）和谵妄（OR=0.3942，95%CI 0.2443-0.6351）与存活出院独立相关。
急诊中心患者的急性症状负担较重，存活出院的可能性比转入的住院患者更大。尽管患者入院时症状严重，但APCU在管理症状以及促进住院患者和急诊中心患者出院回归社区方面取得了成功。
