Tavares Vania, Carron Pierre-Nicolas, Yersin Bertrand, Taffé Patrick, Burnand Bernard, Pittet Valérie
Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.
Emergency Department, Lausanne University Hospital, CH-1011, Lausanne, Switzerland.
Scand J Trauma Resusc Emerg Med. 2016 Aug 24;24(1):103. doi: 10.1186/s13049-016-0294-4.
The use of out-of-hospital emergency medical services by old and very old individuals is increasing. These patients frequently require complex evaluation and decision-making processes to determine a strategy of care, therapeutic choices or withdrawal of care in life-threatening situations. During out-of-hospital missions, thorough decision-making is difficult because of the limited amount of time and lack of direct access to medical charts or to pre-existing advance directives. In this setting, age may be used as a proxy to determine strategy of care, therapeutic choices or withdrawal of care, particularly in relation to advanced medical interventions. We aimed to determine how an emergency physician's initiation of out-of-hospital advanced medical interventions varies with the patient's age.
We performed a retrospective analysis of the missions conducted by the emergency physicians-staffed emergency medical services in a Swiss region. We used logistic regression analysis to determine whether the probability of receiving an advanced medical intervention was associated with the patient's age.
Among 21,922 out-of-hospital emergency adult missions requiring an emergency physician, the probability of receiving an advanced medical intervention decreased with age. It was highest among those aged 18 - 58 years and significantly lower among those aged ≥ 89 years (OR = 0.66; 95 % CI: 0.53 - 0.82). The probability of cardiopulmonary resuscitation attempts progressively decreased with age and was significantly lower for the three oldest age deciles (80 - 83, 84 - 88 and ≥ 89 years).
The number of out-of-hospital advanced medical interventions significantly decreased for patients aged ≥ 89 years. It is unknown whether this lower rate of interventions was related only to age or to other medical characteristics of these patients, such as the number or severity of comorbidities. Thus, further studies are needed to confirm whether this observation corresponds to underuse of advanced medical interventions in very old patients.
老年人和高龄老人使用院外紧急医疗服务的情况正在增加。这些患者在危及生命的情况下，常常需要复杂的评估和决策过程来确定护理策略、治疗选择或停止护理。在院外任务中，由于时间有限且无法直接获取病历或预先存在的预立医疗指示，全面的决策很困难。在这种情况下，年龄可能被用作确定护理策略、治疗选择或停止护理的替代指标，特别是在涉及高级医疗干预方面。我们旨在确定急诊医生启动院外高级医疗干预的情况如何随患者年龄而变化。
我们对瑞士一个地区由配备急诊医生的紧急医疗服务机构执行的任务进行了回顾性分析。我们使用逻辑回归分析来确定接受高级医疗干预的概率是否与患者年龄相关。
在21922例需要急诊医生的院外成人紧急任务中，接受高级医疗干预的概率随年龄降低。在18 - 58岁人群中最高，在89岁及以上人群中显著降低（比值比=0.66；95%置信区间：0.53 - 0.82）。心肺复苏尝试的概率随年龄逐渐降低，在年龄最大的三个十分位数组（80 - 83岁、84 - 88岁和89岁及以上）中显著更低。
89岁及以上患者的院外高级医疗干预数量显著减少。尚不清楚这种较低的干预率是否仅与年龄有关，还是与这些患者的其他医学特征有关，如合并症的数量或严重程度。因此，需要进一步研究来确认这一观察结果是否对应于高龄患者对高级医疗干预的使用不足。
