1 Division of Anesthesia and Critical Care, Critical Care Department, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
2 Critical Care Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia.
J Intensive Care Med. 2019 Jan;34(1):55-61. doi: 10.1177/0885066616686536. Epub 2016 Dec 29.
: To determine resource utilization and outcomes of out-of-hospital transfer patients admitted to the intensive care unit (ICU) of a cancer referral center.
: Single-center cohort.
: A tertiary oncological center.
: Patients older than 18 years transferred to our ICU from an outside hospital between January 2013 and December 2015.
: A total of 2127 (90.3%) were emergency department (ED) ICU admissions and 228 (9.7%) out-of-hospital transfers. The ICU length of stay (LOS) was longer in the out-of-hospital transfers when compared to all other ED ICU admissions ( P = .001); however, ICU and hospital mortality were similar between both groups. The majority of patients were transferred for a higher level of care (77.2%); there was no difference in the amount of interventions performed, ICU LOS, and ICU mortality between nonhigher level-of-care and higher level-of-care patients. Factors associated with an ICU LOS ≥10days were a higher Sequential Organ Failure Assessment (SOFA) score, weekend admissions, presence of shock, need for mechanical ventilation, and acute kidney injury on admission or during ICU stay ( P < .008). The ICU mortality of transferred patients was 17.5% and associated risk factors were older age, higher SOFA score on admission, use of mechanical ventilation and vasopressors during ICU stay, and renal failure on admission ( P < .0001). Data related to the transfer such as LOS at the outside facility, time of transfer, delay in transfer, and longer distance traveled were not associated with increased LOS or mortality in our study.
: Organ failure severity on admission, and not transfer-related factors, continues to be the best predictor of outcomes of critically ill patients with cancer when transferred from other facilities to the ICU. Our data suggest that transferring critically ill patients with cancer to a specialized center does not lead to worse outcomes or increased resource utilization when compared to patients admitted from the ED.
确定转入癌症转诊中心重症监护病房（ICU）的院外转院患者的资源利用和结局。
单中心队列研究。
一家三级肿瘤中心。
2013 年 1 月至 2015 年 12 月期间从外院转入我院 ICU 的年龄大于 18 岁的患者。
共有 2127 例（90.3%）为急诊 ICU 入院，228 例（9.7%）为院外转院。与所有其他 ED ICU 入院相比，院外转院的 ICU 住院时间（LOS）更长（P =.001）；然而，两组 ICU 和医院死亡率相似。大多数患者转院是为了接受更高水平的治疗（77.2%）；非高治疗水平和高治疗水平患者之间的干预次数、ICU LOS 和 ICU 死亡率无差异。与 ICU LOS≥10 天相关的因素包括更高的序贯器官衰竭评估（SOFA）评分、周末入院、休克、需要机械通气和 ICU 住院期间急性肾损伤（P<.008）。转入患者的 ICU 死亡率为 17.5%，相关危险因素为年龄较大、入院时 SOFA 评分较高、ICU 住院期间使用机械通气和血管加压药以及入院时肾衰竭（P<.0001）。在本研究中，与转院相关的数据（如在外部机构的 LOS、转院时间、转院延迟和行驶距离较长）与 LOS 或死亡率的增加无关。
入院时器官衰竭的严重程度，而不是与转院相关的因素，仍然是从其他机构转入 ICU 的癌症危重症患者结局的最佳预测因素。我们的数据表明，与从急诊转入的患者相比，将癌症危重症患者转入专门中心不会导致结局更差或资源利用增加。
