Rocco José Rodolfo, Soares Márcio, Gago Maria de Fátima
Centro de Tratamento Intensivo, Hospital Universitário Clementino Fraga Filho, UFRJ.
Centro de Tratamento Intensivo do Hospital I, Instituto Nacional de Câncer.
Rev Bras Ter Intensiva. 2006 Jun;18(2):114-20.
Information on the outcomes of patients who were refused to the ICU is limited. The aims of this study were to compare the clinical characteristics of patients who were admitted with those of patients who were refused to the ICU and to identify clinical parameters associated with triage procedures.
Observational prospective cohort study. The following data were collected using a standard questionnaire: comorbidities, acute illness, vital status, laboratory data and APACHE II score. The end-points of interest were admission to the ICU and vital status at hospital discharge.
A total of 455 patients were studied; 254 (56%) were admitted and 201 (44%) were not. The main reason for the refuse of admission was the lack of ICU beds (82%). Patients who were not admitted had a higher mortality (85% vs. 61%; p < 0.001). In multivariable analysis, the following variables were associated to non-admission [odds ratio, (95% confidence interval)]: metastatic cancer [5.6(1.7-18.7)], arterial systolic pressure < 90 mmHg [5.2(3.0-8.8)], age > 70 years [4.0(2.4-6.5)], hepatic cirrhosis [3.7(1.8-7.6)], and Glasgow coma scale < 5 [3.6(1.9-6.9)]. The variables associated with ICU admission were: mechanical ventilation [0.5(0.3-0.7)] and acute coronary syndromes [0.1(0.03-0.6)].
Refusal of ICU admission is frequent and generally as a consequence of ICU beds shortage. Patients who were not admitted had a higher mortality. Clinical characteristics associated with the refusal of admission were identified suggesting that they are used in clinical decision-making for ICU triage.
关于被拒绝进入重症监护病房（ICU）患者的预后信息有限。本研究的目的是比较入住ICU患者与被拒绝进入ICU患者的临床特征，并确定与分诊程序相关的临床参数。
观察性前瞻性队列研究。使用标准问卷收集以下数据：合并症、急性疾病、生命状态、实验室数据和急性生理与慢性健康状况评分系统（APACHE II）评分。感兴趣的终点是入住ICU情况和出院时的生命状态。
共研究了455例患者；254例（56%）被收治，201例（44%）未被收治。拒绝收治的主要原因是ICU床位短缺（82%）。未被收治的患者死亡率更高（85%对61%；p<0.001）。在多变量分析中，以下变量与未被收治相关[比值比，（95%置信区间）]：转移性癌症[5.6（1.7 - 18.7）]、动脉收缩压<90 mmHg[5.2（3.0 - 8.8）]、年龄>70岁[4.0（2.4 - 6.5）]、肝硬化[3.7（1.8 - 7.6）]和格拉斯哥昏迷量表<5[3.6（1.9 - 6.9）]。与入住ICU相关的变量是：机械通气[0.5（0.3 - 0.7）]和急性冠状动脉综合征[0.1（0.03 - 0.6）]。
拒绝入住ICU的情况很常见，通常是由于ICU床位短缺。未被收治的患者死亡率更高。确定了与拒绝收治相关的临床特征，表明它们可用于ICU分诊的临床决策。
