Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Department of Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2020 May;83(5):500-506. doi: 10.1097/JCMA.0000000000000297.
Little is known about the characteristics of patients needing palliative care consultation in the emergency department (ED). This study aimed to investigate the impacts of initiating screening in acute critically ill patients needing palliative care on mortality, health care resources, and end-of-life (EOL) care in the intensive care unit in ED (EICU).
We conducted an analysis study in Taipei Veterans General Hospital. From February 1 to July 31, 2018, acute critically ill patients in EICU were recruited. The primary outcomes were inhospital mortality and EOL care. The secondary outcomes included clinical characteristics and health care utilization.
A total of 796 patients were screened, with 396 eligible and 400 noneligible patients needing palliative care consultations. The mean age was 74.8 ± 17.1 years, and 62.6% of the patients were male. According to logistic regression analysis, clinical predictors, including age (adjusted odds ratio [AOR], 1.028; 95% CI, 1.015-1.042), respiratory distress and/or respiratory failure (AOR, 2.670; 95% CI, 1.829-3.897), the Acute Physiology and Chronic Health Evaluation II score (AOR, 1.036; 95% CI, 1.009-1.064), Charlson Comorbidity Index score (AOR, 1.212; 95% CI, 1.125-1.306), and Glasgow Coma Scale (AOR, 0.843; 95% CI, 0.802-0.885), were statistically more significant in eligible patients than in noneligible patients. The inhospital mortality rate was significantly higher in eligible patients than that in noneligible patients (40.7% vs 11.5%, p < 0.01). Eligible patients have a higher ratio in both vasopressor and narcotic use and withdrawal of endotracheal tube than noneligible patients (p < 0.05).
Our study results demonstrated that initiating palliative consultation for acute critically ill patients in ED had an impact on the utilization of health care resources and quality of EOL care. Further assessments of the viewpoints of ED patients and their family on palliative care consultations and hospice care are required.
对于需要在急诊室（ED）接受姑息治疗咨询的患者的特征，我们知之甚少。本研究旨在调查在 ED 重症监护病房（EICU）中对需要姑息治疗的急性危重病患者进行筛查对死亡率、医疗资源和临终关怀（EOL）的影响。
我们在台北荣民总医院进行了一项分析性研究。2018 年 2 月 1 日至 7 月 31 日，我们招募了 EICU 中的急性危重病患者。主要结局为院内死亡率和 EOL 护理。次要结局包括临床特征和医疗保健利用情况。
共对 796 名患者进行了筛查，其中 396 名符合条件，400 名不符合条件，需要姑息治疗咨询。患者的平均年龄为 74.8 ± 17.1 岁，62.6%为男性。根据逻辑回归分析，临床预测因素，包括年龄（调整后的优势比[OR]，1.028；95%CI，1.015-1.042）、呼吸窘迫和/或呼吸衰竭（OR，2.670；95%CI，1.829-3.897）、急性生理学和慢性健康评估 II 评分（OR，1.036；95%CI，1.009-1.064）、Charlson 合并症指数评分（OR，1.212；95%CI，1.125-1.306）和格拉斯哥昏迷量表（OR，0.843；95%CI，0.802-0.885），在符合条件的患者中比在不符合条件的患者中更显著。符合条件的患者的院内死亡率明显高于不符合条件的患者（40.7% vs 11.5%，p<0.01）。与不符合条件的患者相比，符合条件的患者使用血管加压药和麻醉剂以及拔除气管内管的比例更高（p<0.05）。
我们的研究结果表明，在 ED 中对急性危重病患者进行姑息治疗咨询会影响医疗资源的利用和 EOL 护理的质量。需要进一步评估 ED 患者及其家属对姑息治疗咨询和临终关怀的观点。
