Prehosp Emerg Care. 2020 Mar-Apr;24(2):257-264. doi: 10.1080/10903127.2019.1615154. Epub 2019 May 29.
Advance care planning documents, including Physician Orders for Life-Sustaining Treatment (POLST), are intended to guide care near end of life, particularly in emergency situations. Yet, research on POLST during emergency care is sparse. A total of 7,055 injured patients age ≥ 65 years were transported by 8 emergency medical services (EMS) agencies to 23 hospitals in Oregon. We linked multiple data sources to EMS records, including: the Oregon POLST Registry, Medicare claims data, Oregon Trauma Registry, Oregon statewide inpatient data, and Oregon vital statistics records. We describe patient and event characteristics by POLST status at time of 9-1-1 contact, subsequent changes in POLST forms, and mortality to 12 months. Of 7,055 injured older adults, 1,412 (20.0%) had a registered POLST form at the time of 911 contact. Among the 1,412 POLST forms, 390 (27.6%) specified full orders, 585 (41.4%) limited interventions, and 437 (30.9%) comfort measures only. By one year, 2,471 (35%) patients had completed POLST forms. Among the 4 groups (no POLST, POLST-full orders, POLST-limited intervention, POLST-comfort measures), Injury Severity Scores were similar. Mortality differences were present by 30 days (5.0%, 4.6%, 8.0%, and 13.3%, p < 0.01) and were greater by one year (19.5%, 23.9%, 35.4%, and 46.2%, p < 0.01). Among injured older adults transported by ambulance in Oregon, one in 5 had an active POLST form at the time of 9-1-1 contact, the prevalence of which increased over the following year. Mortality differences by POLST status were evident at 30 days and large by one year. This information could help emergency, trauma, surgical, inpatient, and outpatient clinicians understand how to guide patients through acute injury episodes of care and post-injury follow up.
预先医疗指示文件，包括医生的生命维持治疗指令（POLST），旨在指导生命末期的护理，特别是在紧急情况下。然而，关于紧急情况下 POLST 的研究很少。共有 7055 名年龄≥65 岁的受伤患者由 8 个紧急医疗服务（EMS）机构运往俄勒冈州的 23 家医院。我们将多个数据源与 EMS 记录相关联，包括：俄勒冈州 POLST 注册表、医疗保险索赔数据、俄勒冈州创伤登记处、俄勒冈州全州住院数据和俄勒冈州人口统计记录。我们根据 911 联系时的 POLST 状态、随后 POLST 表格的变化以及到 12 个月时的死亡率描述患者和事件特征。在 7055 名受伤的老年人中，有 1412 名（20.0%）在 911 联系时拥有已注册的 POLST 表格。在这 1412 份 POLST 表格中，390 份（27.6%）指定了完整的医嘱，585 份（41.4%）指定了有限的干预措施，437 份（30.9%）指定了仅舒适护理措施。到一年时，2471 名（35%）患者完成了 POLST 表格。在这 4 组（无 POLST、POLST-完整医嘱、POLST-有限干预、POLST-舒适护理）中，伤害严重程度评分相似。30 天时死亡率存在差异（5.0%、4.6%、8.0%和 13.3%，p<0.01），一年时差异更大（19.5%、23.9%、35.4%和 46.2%，p<0.01）。在俄勒冈州由救护车运送的受伤老年人中，五分之一的人在 911 联系时拥有有效的 POLST 表格，并且在接下来的一年中这种情况有所增加。POLST 状态的死亡率差异在 30 天时明显，一年时差异更大。这些信息可以帮助急诊、创伤、外科、住院和门诊临床医生了解如何在急性损伤发作期间和损伤后随访期间指导患者。
