Division of Palliative Medicine, Geneva University Hospitals, Geneva, Switzerland.
Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Palliat Med. 2021 Jan;35(1):161-168. doi: 10.1177/0269216320963931. Epub 2020 Oct 16.
Long-term survival and functional outcomes should influence admission decisions to intensive care, especially for patients with advanced disease.
To determine whether physicians' predictions of long-term prognosis influenced admission decisions for patients with and without advanced disease.
A prospective study was conducted. Physicians estimated patient survival with intensive care and with care on the ward, and the probability of 4 long-term outcomes: leaving hospital alive, survival at 6 months, recovery of functional status, and recovery of cognitive status. Patient mortality at 28 days was recorded. We built multivariate logistic regression models using admission to the intensive care unit (ICU) as the dependent variable.
SETTING/PARTICIPANTS: ICU consultations for medical inpatients at a Swiss tertiary care hospital were included.
Of 201 evaluated patients, 105 (52.2%) had an advanced disease and 140 (69.7%) were admitted to the ICU. The probability of admission was strongly associated with the expected short-term survival benefit for patients with or without advanced disease. In contrast, the predicted likelihood that the patient would leave the hospital alive, would be alive 6 months later, would recover functional status, and would recover initial cognitive capacity was not associated with the decision to admit a patient to the ICU. Even for patients with advanced disease, none of these estimated outcomes influenced the admission decision.
ICU admissions of patients with advanced disease were determined by short-term survival benefit, and not by long-term prognosis. Advance care planning and developing decision-aid tools for triage could help limit potentially inappropriate admissions to intensive care.
长期生存和功能结果应影响重症监护的入院决策，尤其是对于晚期疾病患者。
确定医生对长期预后的预测是否会影响有无晚期疾病患者的入院决策。
前瞻性研究。医生估计患者接受重症监护和病房护理的生存概率，以及 4 种长期预后的概率：出院后存活、6 个月存活、功能状态恢复和认知状态恢复。记录患者 28 天死亡率。我们使用入住重症监护病房（ICU）作为因变量构建了多变量逻辑回归模型。
设置/参与者：包括瑞士三级保健医院的 ICU 会诊的内科住院患者。
在评估的 201 名患者中，105 名（52.2%）患有晚期疾病，140 名（69.7%）被收入 ICU。预期短期生存获益与有无晚期疾病患者的入院概率密切相关。相比之下，预测患者出院后存活、6 个月后存活、恢复功能状态和恢复初始认知能力的可能性与将患者收入 ICU 的决策无关。即使对于患有晚期疾病的患者，这些估计结果也没有一个影响入院决策。
晚期疾病患者的 ICU 入院决策取决于短期生存获益，而不是长期预后。预先护理计划和开发分诊决策辅助工具可以帮助限制对重症监护的潜在不适当入院。
