Williams Molly T, Zimmerman Eli, Barry Megan, Trantum Lindsay, Dietrich Mary S, Doersam Jennifer K, Karlekar Mohana
1 Division of Internal Medicine, Palliative Care, Vanderbilt University Medical Center, Nashville, TN, USA.
2 Division of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
Am J Hosp Palliat Care. 2019 Jan;36(1):60-64. doi: 10.1177/1049909118787136. Epub 2018 Jul 10.
Despite advances in stroke care, patients continue to incur significant disability, are at risk for future events, and are inconsistently comanaged with palliative care (PC) specialty teams. The purpose of this study was to review patients with stroke admitted to our institution, comparing patients with and without PC consultation. We retrospectively reviewed medical record data of all patients with stroke admitted to our neurosciences ICU (NICU) in July 2014 to June 2015 with and without PC consultation. Review focused on stroke type, patient demographics, median days to discharge and death, and posthospitalization discharge. Of 463 patients admitted to the NICU with a stroke diagnosis, 27% (125/463) had (PC) consultation. A higher percentage of the patients with PC consult presented with hemorrhagic stroke than those without PC consult (38% vs 21%, P < .001). Patients with PC consult had longer median days to discharge and death ( P < .001) and a higher percentage of mortality (32% vs 11%). Of the 301 patients without PC consult who discharged (89.1%), 36.5% discharged to inpatient rehab while 10% discharged to a skilled nursing facility. In comparison, of the patients with PC consultation who discharged alive (41.1%), 15.7% discharged to inpatient rehab whereas 39% discharged to skilled nursing ( P < .001). The uncertainty of which patients with stroke benefit most from specialty PC is highlighted in that although sicker patients are referred to PC, a substantial portion (41%) of these patients discharge alive, of which 39.2% discharged to skilled nursing. Future research should focus on which patients with stroke would benefit from specialty PC.
尽管中风护理取得了进展，但患者仍会出现严重残疾，面临未来再次发病的风险，并且在接受姑息治疗（PC）专科团队联合管理方面存在不一致的情况。本研究的目的是回顾我院收治的中风患者，比较接受和未接受PC会诊的患者情况。我们回顾性地中风患者的病历数据进行了回顾性分析，这些患者于2014年7月至2015年6月入住我院神经科学重症监护病房（NICU），有接受或未接受PC会诊的情况。审查重点包括中风类型、患者人口统计学特征、出院和死亡的中位天数以及出院后的情况。在463名被诊断为中风并入住NICU的患者中，27%（125/463）接受了PC会诊。接受PC会诊的患者中，出血性中风的比例高于未接受PC会诊的患者（38%对21%，P < 0.001）。接受PC会诊的患者出院和死亡的中位天数更长（P < 0.001），死亡率更高（32%对11%）。在301名未接受PC会诊而出院的患者中（89.1%），36.5%出院后进入住院康复机构，10%出院后进入专业护理机构。相比之下，在接受PC会诊且存活出院的患者中（41.1%），15.7%出院后进入住院康复机构，而39%出院后进入专业护理机构（P < 0.001）。中风患者中哪些患者能从专科PC中获益最大存在不确定性，这一点很突出，因为尽管病情较重的患者被转介到PC，但这些患者中有很大一部分（41%）存活出院，其中39.2%出院后进入专业护理机构。未来的研究应关注哪些中风患者能从专科PC中获益。
