一级学术创伤中心姑息治疗会诊的特点
Characteristics of palliative care consultation at an academic level one trauma center.
作者信息
Rivet Emily B, Ferrada Paula, Albrecht Tara, Cassel J Brian, Broering Beth, Noreika Danielle, Del Fabbro Egidio
机构信息
Departments of Surgery and Internal Medicine, VCU School of Medicine, Richmond, VA, USA.
Department of Surgery, VCU School of Medicine, Richmond, VA, USA.
出版信息
Am J Surg. 2017 Oct;214(4):657-660. doi: 10.1016/j.amjsurg.2017.06.010. Epub 2017 Jun 28.
BACKGROUND
The current status of palliative care consultation for trauma patients has not been well characterized. We hypothesized that palliative care consultation currently is requested for patients too late to have any clinical significance.
METHODS
A retrospective chart review was performed for traumatically injured patients' ≥18 years of age who received palliative care consultation at an academic medical center during a one-year period.
RESULTS
The palliative care team evaluated 82 patients with a median age of 60 years. Pain and end of life were the most common reasons for consultation; interventions performed included delirium management and discussions about nutritional support. For decedents, median interval from palliative care consultation to death was 1 day. Twenty seven patients died (11 in the palliative care unit, 16 in an ICU). Nine patients were discharged to hospice.
CONCLUSIONS
Most consultations were performed for pain and end of life management in the last 24 h of life, demonstrating the opportunity to engage the palliative care service earlier in the course of hospitalization.
背景
创伤患者姑息治疗会诊的现状尚未得到充分描述。我们推测，目前对患者进行姑息治疗会诊的时间过晚，已无任何临床意义。
方法
对一家学术医疗中心在一年期间接受姑息治疗会诊的18岁及以上创伤患者进行回顾性病历审查。
结果
姑息治疗团队评估了82例患者，中位年龄为60岁。疼痛和生命末期是最常见的会诊原因；实施的干预措施包括谵妄管理和关于营养支持的讨论。对于死者，从姑息治疗会诊到死亡的中位间隔时间为1天。27例患者死亡（11例在姑息治疗病房，16例在重症监护病房）。9例患者出院后进入临终关怀机构。
结论
大多数会诊是在生命的最后24小时内为疼痛和生命末期管理进行的，这表明有机会在住院过程中更早地引入姑息治疗服务。
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