Lopez Santiago, Finuf Kayla D, Marziliano Allison, Sinvani Liron, Burns Edith A
Division of Geriatrics and Palliative Medicine, Department of Medicine, Zucker School of Medicine at Hofstra Northwell, Manhasset, New York, USA.
The Feinstein Institute for Medical Research, Center for Health Innovation and Outcomes Research (CHIOR), Department of Medicine, Northwell Health, Manhasset, New York, USA.
J Pain Symptom Manage. 2021 Aug;62(2):267-276. doi: 10.1016/j.jpainsymman.2020.12.015. Epub 2021 Jan 29.
Few studies have described the characteristics and palliative care needs in hospitalized patients with coronavirus disease 2019 (COVID-19).
Describing characteristics, consultation demands, patients' needs, and outcomes of hospitalized patients with COVID-19 who received a palliative care evaluation.
Retrospective chart review of patients (aged 18+ years) with COVID-19 admitted to an academic quaternary center and seen by the geriatrics and palliative medicine team from March 1st to May 11th, 2020. Socio-demographics, operational metrics, severity of illness, goals of care-advanced care planning documentation, and outcomes were analyzed.
Three hundred seventy-six (17.6%) out of 2138 COVID-19 admissions were seen by the consultation team. Compared with prepandemic situation (September 1st, 2019, to February 29th, 2020), overall new consults (205 vs. 371, P < 0.001) significantly increased, particularly in the intensive care unit (ICU; 9.5% vs. 36.9%, P < 0.001). For the COVID-19 population, median age was 78 years (interquartile range, 70-87; range, 36-102); 56% were male. LACE score, D-dimer, and C-reactive protein suggested severe disease and increased risk of mortality. Seventy-five percent of consults were for goals of care-advanced care planning, and 9.6% for symptoms. During the index admission, 7.1% had documented advanced directives, and 69.7% became do not resuscitate. Of all deaths, 55.5% were in the ICU, and 87.2% were aged ≥65 years. Underserved minority patients had a disproportionate mortality. Overall consultation mortality (38.3% vs. 70.4%, P < 0.001) and ICU mortality (55.2% vs. 78.1%, P < 0.001) significantly increased compared with those before COVID-19.
During this pandemic, understanding inpatient specialized palliative care needs and the vulnerable populations driving these causes may encourage health-care agencies and local, state, and federal governments to support the dedicated palliative care workforce.
很少有研究描述2019冠状病毒病（COVID-19）住院患者的特征和姑息治疗需求。
描述接受姑息治疗评估的COVID-19住院患者的特征、会诊需求、患者需求及结局。
对2020年3月1日至5月11日入住一所学术性四级医疗中心并由老年病学和姑息医学团队诊治的18岁及以上COVID-19患者进行回顾性病历审查。分析社会人口统计学、操作指标、疾病严重程度、护理目标——高级护理计划文件及结局。
2138例COVID-19住院患者中有376例（17.6%）接受了会诊团队的诊治。与疫情前情况（2019年9月1日至2020年2月29日）相比，总体新会诊数量（205例对371例，P<0.001）显著增加，尤其是在重症监护病房（ICU；9.5%对36.9%，P<0.001）。对于COVID-19患者群体，中位年龄为78岁（四分位间距，70 - 87岁；范围，36 - 102岁）；56%为男性。LACE评分、D - 二聚体和C反应蛋白提示疾病严重且死亡风险增加。75%的会诊是为了护理目标——高级护理计划，9.6%是为了症状。在本次住院期间，7.1%的患者有记录在案的预立医嘱，69.7%的患者成为不进行心肺复苏的对象。在所有死亡病例中，55.5%在ICU，87.2%年龄≥65岁。未得到充分服务的少数族裔患者死亡率过高。与COVID-19之前相比，总体会诊死亡率（38.3%对70.4%，P<0.001）和ICU死亡率（55.2%对78.1%，P<0.001）显著增加。
在此次疫情期间，了解住院患者的专科姑息治疗需求以及导致这些需求的弱势群体情况，可能会促使医疗机构以及地方、州和联邦政府支持专业的姑息治疗人员队伍。
