Osterthun R, van Asbeck F W A, Nijendijk J H B, Post M W M
Jeroen Bosch Hospital, Tolbrug Rehabilitation Centre, Groningen, The Netherlands.
University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands.
Spinal Cord. 2016 Nov;54(11):1025-1030. doi: 10.1038/sc.2016.37. Epub 2016 Apr 12.
Explorative retrospective files study.
To document end-of-life decisions (ELDs) in in-hospital deaths after new traumatic spinal cord injury (TSCI).
The Netherlands.
Discharge letters concerning patients with TSCI discharged from Dutch acute hospitals in 2010 were analysed. Data were extracted on survival, personal and lesion characteristics, comorbidities, other injuries, preexisting spinal stenosis, stabilising surgery, length of hospital stay and the presence and types of ELDs. Characteristics of deceased patients and survivors were compared using χ and T-tests. Characteristics of the deceased patients and ELDs were further explored.
A total of 185 patients with new TSCI were identified. Twenty-six patients were excluded as their survival status at discharge was unknown-for example, because of discharge to another hospital without information about their final discharge. Thirty of the remaining 159 patients died during their initial hospital stay (18.9%). Deceased patients were older and had more often high cervical and motor complete injuries than survivors. The circumstances of death were sparsely documented, and in nine cases, it was not possible to determine the absence or the presence of an ELD. ELDs were reported in 19 deaths (63.3%). All were non-treatment decisions, and almost all (89.5%) were decisions of withdrawal of treatment. There were no cases of documented euthanasia or physician-assisted suicide.
ELDs were reported in the majority of in-hospital deaths after new TSCI in the Netherlands (63.3%), and all were non-treatment decisions.
探索性回顾性档案研究。
记录新发性创伤性脊髓损伤（TSCI）后院内死亡的临终决策（ELDs）。
荷兰。
分析了2010年从荷兰急性医院出院的TSCI患者的出院小结。提取了关于生存情况、个人和损伤特征、合并症、其他损伤、既往存在的椎管狭窄、稳定手术、住院时间以及ELDs的存在情况和类型的数据。使用χ检验和T检验比较了死亡患者和存活患者的特征。对死亡患者的特征和ELDs进行了进一步探讨。
共确定了185例新发性TSCI患者。26例患者被排除，因为他们出院时的生存状况未知，例如，因转至另一家医院且无最终出院信息。其余159例患者中有30例在初次住院期间死亡（18.9%）。死亡患者比存活患者年龄更大，高位颈椎损伤和运动完全性损伤更为常见。死亡情况记录稀少，9例无法确定是否存在ELD。19例死亡（63.3%）报告了ELD。均为不治疗决策，几乎所有（89.5%）都是撤掉治疗的决策。没有记录在案的安乐死或医生协助自杀病例。
在荷兰，新发性TSCI后院内死亡的大多数（63.3%）报告了ELD，且均为不治疗决策。
