谁能从临终时积极的快速反应系统治疗中获益？一项回顾性队列研究。

Who Benefits from Aggressive Rapid Response System Treatments Near the End of Life? A Retrospective Cohort Study.

作者信息

Cardona Magnolia, Turner Robin M, Chapman Amanda, Alkhouri Hatem, Lewis Ebony T, Jan Stephen, Nicholson Margaret, Parr Michael, Williamson Margaret, Hillman Ken

机构信息

The Simpson Centre for Health Services Research, South Western Sydney Clinical School, The University of New South Wales, Sydney.

Biostatistics, Dean's Office Dunedin School of Medicine, University of Otago, Dunedin, New Zealand and formerly Senior Lecturer, Epidemiology, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia; Liverpool Hospital, Liverpool, Australia.

出版信息

Jt Comm J Qual Patient Saf. 2018 Sep;44(9):505-513. doi: 10.1016/j.jcjq.2018.04.001. Epub 2018 Jun 27.

DOI:10.1016/j.jcjq.2018.04.001

PMID:30166034

Abstract

BACKGROUND

Many patients near the end of life are subject to rapid response system (RRS) calls. A study was conducted in a large Sydney teaching hospital to identify a cutoff point that defines nonbeneficial treatment for older hospital patients receiving an RRS call, describe interventions administered, and measure the cost of hospitalization.

METHODS

This was a retrospective cohort of 733 adult inpatients with data for the period three months before and after their last placed RRS call. Subgroup analysis of patients aged ≥ 80 years was conducted. Log-rank, chi-square, and t-tests were used to compare survival, and logistic regression was used to examine predictors of death.

RESULTS

Overall, 65 (8.9%) patients had a preexisting not-for-resuscitation (NFR) or not-for-RRS order; none of those patients survived to three months. By contrast, patients without an NFR or not-for-RRS order had three-month survival probability of 71% (log-rank χ 145.63; p < 0.001). Compared with survivors, RRS recipients who died were more likely to be older, to be admitted to a medical ward, and to have a larger mean number of admissions before the RRS. The average cost of hospitalization for the very old transferred to the ICU was higher than for those not requiring treatment in the ICU (US$33,990 vs. US$14,774; p = 0.045).

CONCLUSION

Identifiable risk factors clearly associated with poor clinical outcomes and death can be used as a guide to administer less aggressive treatments, including reconsideration of ICU transfers, adherence to NFR orders, and transition to end-of-life management instead of calls to the RRS team.

摘要

背景

许多临终患者会触发快速反应系统（RRS）呼叫。在悉尼一家大型教学医院开展了一项研究，以确定一个界定值，该界定值用于判定接受RRS呼叫的老年住院患者接受无意义治疗的情况，描述所实施的干预措施，并衡量住院费用。

方法

这是一项回顾性队列研究，纳入了733名成年住院患者，收集了他们最后一次触发RRS呼叫前三个月和后三个月的数据。对年龄≥80岁的患者进行了亚组分析。采用对数秩检验、卡方检验和t检验比较生存率，并采用逻辑回归分析死亡的预测因素。

结果

总体而言，65名（8.9%）患者预先存在不进行心肺复苏（NFR）或不触发RRS的医嘱；这些患者无一存活至三个月。相比之下，没有NFR或不触发RRS医嘱的患者三个月生存率为71%（对数秩χ145.63；p<0.001）。与幸存者相比，触发RRS后死亡的患者更可能年龄较大、入住内科病房，且在触发RRS之前平均住院次数更多。转入重症监护病房（ICU）的高龄患者平均住院费用高于不需要在ICU治疗的患者（33,990美元对14,774美元；p=0.045）。