Quadri Syed Z, Huynh Thang, Cappelen-Smith Cecilia, Wijesuriya Nirupama, Mamun Abul, Beran Roy G, McDougall Alan J, Cordato Dennis
Department of Palliative Medicine, Liverpool Hospital, Sydney, Liverpool, New South Wales, Australia.
Sydney South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
Intern Med J. 2018 Mar;48(3):330-334. doi: 10.1111/imj.13619.
The benefit of palliative care referral for severe stroke patients on end-of-life care pathway (EOLCP) is increasingly recognised. Palliative care provides assistance with symptom management and transition to end-of-life care. Advance care planning (ACP) may help accommodate patient/family expectations and guide management.
This is a retrospective study of all stroke deaths (2014-2015) at Liverpool Hospital, Sydney, Australia. Data examined included age, comorbidities, living arrangements, pre-existing ACP, palliative care referral rates and 'survival time'.
In total, 123 patient (mean age ± SD = 76 ± 13 years) deaths were identified from 1067 stroke admissions (11.5% mortality); 64 (52%) patients had ischaemic stroke and 59 (48%) intracerebral haemorrhage (ICH), and 40% suffered a prior stroke, and 43% required a carer at home or were in an aged care facility. Survival time from admission was significantly longer in patients with ischaemic stroke compared to intracerebral haemorrhage (median, interquartile range [IQR]: 9.5 [18] vs 2 [4] days, P < 0.001). Only two patients had pre-existing ACP; 44% of patients were referred to palliative care and 41% were commenced on dedicated EOLCP. Palliative care referral was less likely in patients who died under neurosurgery. EOLCP were significantly less likely to be commenced in patients who underwent acute intervention or were not referred to palliative care.
In this cohort, palliative care referral and EOLCP were commenced in less than 50% of patients, highlighting significant variations in clinical care. These data support the need to promote awareness of ACP, particularly in patients with prior stroke or significant comorbidities. This may help reduce potentially futile invasive investigations and treatment.
姑息治疗对处于临终关怀路径（EOLCP）的重症中风患者的益处日益得到认可。姑息治疗为症状管理和向临终关怀的过渡提供帮助。预先护理计划（ACP）可能有助于满足患者/家属的期望并指导管理。
这是一项对澳大利亚悉尼利物浦医院所有中风死亡病例（2014 - 2015年）的回顾性研究。检查的数据包括年龄、合并症、生活安排、预先存在的ACP、姑息治疗转诊率和“生存时间”。
从1067例中风入院病例中总共确定了123例患者死亡（死亡率为11.5%）；64例（52%）患者为缺血性中风，59例（48%）为脑出血（ICH），40%的患者曾有过中风，43%的患者在家需要护理人员或住在老年护理机构。与脑出血患者相比，缺血性中风患者从入院起的生存时间显著更长（中位数，四分位间距[IQR]：9.5[18]天对2[4]天，P < 0.001）。只有两名患者预先存在ACP；44%的患者被转诊至姑息治疗，41%的患者开始接受专门的EOLCP。在神经外科手术下死亡的患者中，转诊至姑息治疗的可能性较小。在接受急性干预或未转诊至姑息治疗的患者中，开始接受EOLCP的可能性显著较小。
在该队列中，不到50%的患者开始接受姑息治疗转诊和EOLCP，突出了临床护理中的显著差异。这些数据支持提高对ACP的认识的必要性，特别是在既往有中风或严重合并症的患者中。这可能有助于减少潜在的无效侵入性检查和治疗。
