Amado Jose P, Vasquez Rolando, Huari Roberto W, Sucari Andrea S, Oscanoa Teodoro J
Emergency Department, Rebagliati Hospital - Essalud, Lima, Peru.
Medicine School, Universidad Nacional Mayor De San Marcos, Lima, Peru.
Indian J Palliat Care. 2018 Jan-Mar;24(1):25-27. doi: 10.4103/IJPC.IJPC_108_17.
In the last decades, patients with chronic terminal diseases have had more frequent visits to emergency services.
This study aims to determine the proportion of terminal illness in patients readmitted to emergency room, to evaluate the use of this service and rate of death.
A cross-sectional study in a tertiary hospital with 120 stretchers which annually reports 160 thousand attentions and 22 thousand admissions.
Included 18-year-old patients or older who were readmitted to emergency room. Patient and/or caregiver were interviewed; medical record was reviewed and made 1-year follow-up. Terminal cancer was determined by histologically confirmation in Stage IV and nononcologic terminal disease by total functional dependence (Katz index) or severe cognitive impairment (Pfeiffer questionnaire) in addition of advanced organ failure.
Fisher's exact and U of Mann-Whitney tests for two independent samples.
Ninety-two (26%) of 349 were readmissions; 29 (36.7%) of 79 evaluated patients were identifying with terminal disease. Eleven (38%) of them had cancer (genitourinary in 64%). Nononcologic terminal disease was identified in 18 cases (62%) (Neurodegenerative involvement in 50%). More frequent symptoms were dyspnea 41%, mental confusion 24%, and pain 21%. Terminal patients had 6.2 (standard deviation 8.2) emergency visits at last year, being admitted 48,6% of these visits. Six-month mortality rate was 73 and 61% in oncologic and nononcolgic patients, respectively ( < 0.05).
End-stage disease is frequent in readmitted patients to emergency, more of nononcologic kind. These patients use frequently emergency service, with high mortality (more elevated in oncologic).
在过去几十年中，患有慢性终末期疾病的患者前往急诊服务的次数更为频繁。
本研究旨在确定再次入住急诊室的患者中终末期疾病的比例，评估该服务的使用情况和死亡率。
在一家拥有120张担架床的三级医院进行的横断面研究，该医院每年报告16万次就诊和2.2万次住院。
纳入18岁及以上再次入住急诊室的患者。对患者和/或照顾者进行访谈；查阅病历并进行1年随访。终末期癌症通过组织学确诊为IV期，非肿瘤性终末期疾病通过完全功能依赖（Katz指数）或严重认知障碍（Pfeiffer问卷）以及晚期器官衰竭来确定。
对两个独立样本采用Fisher精确检验和Mann-Whitney U检验。
349例中有92例（26%）再次入院；79例评估患者中有29例（36.7%）被确定为患有终末期疾病。其中11例（38%）患有癌症（64%为泌尿生殖系统癌症）。18例（62%）被确定为非肿瘤性终末期疾病（50%为神经退行性病变）。较常见的症状为呼吸困难41%、精神错乱24%和疼痛21%。终末期患者去年平均有6.2次（标准差8.2）急诊就诊，其中48.6%的就诊导致住院。肿瘤性和非肿瘤性患者的6个月死亡率分别为73%和61%（P<0.05）。
再次入住急诊的患者中终末期疾病很常见，非肿瘤性的更多。这些患者频繁使用急诊服务，死亡率高（肿瘤性患者更高）。
