Ross Lauren, Taverner John, John Jennifer, Baisch Andreas, Irving Louis, Philip Jennifer, Smallwood Natasha
Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Department of Rural Health, University of Melbourne, Northeast Health Wangaratta, Wangaratta, Victoria, Australia.
Intern Med J. 2021 Nov;51(11):1835-1839. doi: 10.1111/imj.14943. Epub 2021 Oct 23.
Chronic obstructive pulmonary disease (COPD) is an incurable, chronic condition that leads to significant morbidity and mortality, with most patients dying in hospital. While diagnostic tests are important for actively managing patients during hospital admissions, the balance between benefit and harm should always be considered. This is particularly important when patients reach the end of life, when the focus is to reduce burdensome interventions.
To examine the use of diagnostic testing in a cohort of people with COPD who died in hospital.
Retrospective medical record audits were completed at two Australian hospitals (Royal Melbourne Hospital and Northeast Health Wangaratta), with all patients who died from COPD over 12 years between 1 January 2004 and 31 December 2015 included.
Three hundred and forty-three patients were included, with a median of 11 diagnostic testing episodes per patient. Undergoing higher numbers of diagnostic tests was associated with younger age, intensive care unit admission and non-invasive ventilation use. Reduced testing was associated with recent hospital admission for COPD, domiciliary oxygen use and a prior admission with documentation limiting medical treatment. Most patients underwent diagnostic tests in the last 2 days of life, and 12% of patients had ongoing diagnostic tests performed after a documented decision was made to change the goal of care to provide comfort care only.
There were missed opportunities to reduce the burden of diagnostic tests and focus on comfort at the end of life. Increased physician education regarding communication and end-of-life care, including recognising active dying may address these issues.
慢性阻塞性肺疾病（COPD）是一种无法治愈的慢性疾病，会导致严重的发病率和死亡率，大多数患者在医院死亡。虽然诊断测试对于在住院期间积极管理患者很重要，但始终应考虑利弊平衡。当患者接近生命终点时，这一点尤为重要，此时重点是减少繁重的干预措施。
研究在一组死于医院的慢性阻塞性肺疾病患者中诊断测试的使用情况。
在两家澳大利亚医院（皇家墨尔本医院和旺加拉塔东北健康医院）完成了回顾性病历审核，纳入了2004年1月1日至2015年12月31日期间12年中所有死于慢性阻塞性肺疾病的患者。
纳入了343名患者，每位患者的诊断测试次数中位数为11次。进行更多的诊断测试与年龄较小、入住重症监护病房和使用无创通气有关。测试减少与近期因慢性阻塞性肺疾病住院、在家使用氧气以及之前住院时有记录限制医疗治疗有关。大多数患者在生命的最后2天接受了诊断测试，12%的患者在记录决定将护理目标改为仅提供舒适护理后仍在进行诊断测试。
在减少诊断测试负担和关注生命终点的舒适度方面存在错失的机会。加强医生关于沟通和临终护理的教育，包括认识到濒死状态，可能会解决这些问题。
