≥75 岁快速反应团队患者的特征和结局：一项前瞻性观察队列研究。
Characteristics and outcome of rapid response team patients ≥75 years old: a prospective observational cohort study.
机构信息
Department of Intensive Care Medicine, Tampere University Hospital, Department of Anaesthesiology and Intensive Care Medicine, Seinäjoki Central Hospital, University of Tampere, PO Box 2000, FI-33521, Tampere, Finland.
Emergency Medical Service, FinnHEMS 30, Tampere University Hospital, University of Tampere, PO Box 2000, FI-33521, Tampere, Finland.
出版信息
Scand J Trauma Resusc Emerg Med. 2017 Aug 4;25(1):77. doi: 10.1186/s13049-017-0423-8.
BACKGROUND
Rapid response teams (RRTs) attend severely ill general ward patients whose average 30-day mortality is near 30%. A major part of RRT patients are over 75 years old, but there are no studies on the characteristics and outcome of this geriatric RRT population. We compared the characteristics and outcome of geriatric RRT sub-population with the RRT patients <75 years old. We further investigated, whether the accumulation of risk factors (RFs) for mortality among the general RRT population predicts a tenuous outcome among the geriatric sub-population.
METHODS
Prospective three-year observational cohort study of adult RRT patients in Tampere University Hospital, Finland. After identifying independent RFs for 30-day mortality among RRT patients with multivariate logistic regression, we further studied the impact of the accumulation of these RFs among geriatric RRT patients who had no limitations of medical treatment.
RESULTS
A total of 1372 patients were reviewed 1722 times. Geriatric patients (n = 449, 33%), when compared to non-geriatric patients, had higher 30-day (33% vs. 21%, respectively; p < 0.001) and one-year (54% vs. 35%, respectively; p < 0.001) mortality rates. Among the general RRT population, positive RRT criteria as measured by RRT during the review, high comorbidity index, age ≥ 75 years, non-elective hospital admission, medical reason for admission and afferent limb failure were identified as independent RFs for 30-day mortality and classified as feasible to obtain during a routine RRT review. The observed rates of these RFs among the geriatric RRT patients substantially affected their 30-day mortality (e.g. no RFs: 5.3%; one RF: 14%; two RFs: 27%; three RFs: 38%; four RFs: 52%; five RFs: 38%).
CONCLUSIONS
One-third of patients reviewed by RRT were ≥75 years old, and age statistics were comparable to previous RRT studies suggesting that this is the case globally. Outcome of geriatric RRT patients is poorer as compared with RRT patients <75 years. However, the outcome is substantially affected by the accruement (or lack) of RFs generally increasing the mortality of RRT patients. Considering these factors during a geriatric RRT review may aid with the decision to either escalate or de-escalate care.
背景
快速反应团队（RRT）负责照顾病情严重的普通病房患者，这些患者的平均 30 天死亡率接近 30%。RRT 患者中有很大一部分年龄在 75 岁以上，但目前尚无针对这一老年 RRT 人群特征和结局的研究。我们比较了老年 RRT 亚人群与年龄<75 岁的 RRT 患者的特征和结局。我们进一步调查了一般 RRT 人群中死亡风险因素（RFs）的积累是否预示着老年亚人群的预后不良。
方法
这是一项前瞻性的、为期三年的芬兰坦佩雷大学医院成年 RRT 患者的观察队列研究。我们通过多变量逻辑回归确定了 RRT 患者 30 天死亡率的独立 RFs 后，进一步研究了在没有医疗限制的情况下，这些 RFs 在老年 RRT 患者中的积累对预后的影响。
结果
共回顾了 1372 名患者 1722 次。与非老年患者相比，老年患者（n=449，33%）的 30 天（分别为 33%和 21%；p<0.001）和 1 年（分别为 54%和 35%；p<0.001）死亡率更高。在一般 RRT 人群中，通过 RRT 审查期间的 RRT 来衡量的阳性 RRT 标准、高合并症指数、年龄≥75 岁、非择期入院、入院原因和传入肢体衰竭被确定为 30 天死亡率的独立 RFs，并被归类为在常规 RRT 审查期间可以获得。在老年 RRT 患者中观察到的这些 RFs 的发生率显著影响了他们的 30 天死亡率（例如，无 RFs：5.3%；一个 RF：14%；两个 RFs：27%；三个 RFs：38%；四个 RFs：52%；五个 RFs：38%）。
结论
接受 RRT 审查的患者中有三分之一年龄≥75 岁，年龄统计数据与之前的 RRT 研究相当，表明这是全球范围内的情况。与年龄<75 岁的 RRT 患者相比，老年 RRT 患者的结局较差。然而，结局受到 RFs 积累（或缺乏）的显著影响，这通常会增加 RRT 患者的死亡率。在老年 RRT 审查期间考虑这些因素可能有助于决定是升级还是降级治疗。
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