Department of Emergency Medicine, Unit 1468, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA.
Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Support Care Cancer. 2019 Jul;27(7):2649-2655. doi: 10.1007/s00520-018-4554-x. Epub 2018 Nov 24.
Consultation to palliative care (PC) services in hospitalized patients is frequently late after admission to a hospital. The purpose of this study is to examine the association of in-hospital mortality and timing of palliative care consultation in cancer patients admitted through the emergency department (ED) of MD Anderson Cancer Center.
Institutional databases were queried for unique medical admissions over a period of 1 year. Primary cancer type, ED versus direct admission, length of stay (LOS), presenting symptoms, and in-hospital mortality were reviewed; patient data were analyzed, and risk factors for in-hospital mortality were identified. The association of early palliative care consultation (within 3 days of admission) with these outcomes was studied. Descriptive statistics and multivariate logistic regression model were used.
Equal numbers of patients were admitted directly versus through the ED (7598 and 7538 respectively). However, of all patients who died in the hospital, 990 (88%) were admitted through the ED, compared with 137 admitted directly (P < 0.001). Patients who died in the hospital had longer median LOS compared with patients who were discharged alive (11 vs. 4 days, respectively, P < 0.001). Early palliative care consultation was associated with decreased mortality, compared with late consultation (P < 0.001). Chief complaints of respiratory problems, neurologic issues, or fatigue/weakness were significantly associated with in-hospital mortality.
We found an association between ED admission and hospital mortality. Decedent cancer patients had a prolonged LOS, and early palliative care consultation for terminally ill symptomatic patients may prevent in-hospital mortality and improve quality of cancer care.
在住院患者中，姑息治疗（PC）服务的咨询通常在入院后很晚才进行。本研究的目的是探讨 MD 安德森癌症中心急诊科（ED）收治的癌症患者中，姑息治疗咨询的时间与住院患者死亡率之间的关系。
在为期 1 年的时间内，通过机构数据库查询唯一的医疗入院记录。回顾主要癌症类型、ED 与直接入院、住院时间（LOS）、就诊症状和住院死亡率；分析患者数据，并确定住院死亡率的危险因素。研究早期姑息治疗咨询（入院后 3 天内）与这些结果的关系。使用描述性统计和多变量逻辑回归模型。
直接入院和 ED 入院的患者数量相等（分别为 7598 例和 7538 例）。然而，所有在医院死亡的患者中，有 990 例（88%）是通过 ED 入院的，而直接入院的只有 137 例（P < 0.001）。与存活出院的患者相比，在医院死亡的患者的中位 LOS 更长（分别为 11 天和 4 天，P < 0.001）。与晚期咨询相比，早期姑息治疗咨询与死亡率降低相关（P < 0.001）。呼吸问题、神经问题或疲劳/虚弱等主要主诉与住院死亡率显著相关。
我们发现 ED 入院与医院死亡率之间存在关联。死亡癌症患者的 LOS 延长，对终末期症状患者进行早期姑息治疗咨询可能会预防住院死亡率，并提高癌症护理质量。
