Medical School, University of Michigan, Ann Arbor, Michigan.
Center for Bioethics and Social Sciences in Medicine and.
Hosp Pediatr. 2021 Apr;11(4):411-416. doi: 10.1542/hpeds.2020-001248. Epub 2021 Mar 15.
We sought to examine whether sociodemographic differences, such as race and socioeconomic status, existed between patients in the PICU, pediatric cardiothoracic ICU (PCTU), and NICU who were identified as having ethical issues during interprofessional ethics rounds and all other patients admitted to these units and to characterize the primary ethical issues identified in this context.
We compared sociodemographic factors among patients admitted to a quaternary academic children's hospital between January 2017 and December 2018 who were identified as having ethical issues during PICU, PCTU, and NICU interprofessional ethics rounds ( = 122) with those of all other patients admitted to these units ( = 4971). χ tests or Fisher's exact tests, Mann-Whitney tests, and a multivariable logistic regression analysis were performed.
With bivariate analyses, we detected significant differences by race, insurance type, and ventilator dependence, but no significant differences between the 2 groups existed on the basis of sex, ethnicity, religion, primary language, age, or a socioeconomic status metric. After we adjusted for confounders using a multivariable logistic regression analysis, only patients who were ventilator dependent were at significantly higher odds (odds ratio = 5.78; confidence interval = 3.69-9.04; < .001) of being identified as having ethical issues. Goals of care was the most frequent ethical issue (44%).
Except for ventilator dependence, patients with ethical issues during PICU, PCTU, and NICU interprofessional ethics rounds are demographically similar to overall patients admitted in these units. Future research should be used to assess whether proactive rounds impact the timing of ethics consultation requests as well as to determine if interprofessional ethics rounds influence volume and acuity in formal ethics consultation practices.
我们旨在研究在跨专业伦理查房中确定存在伦理问题的儿科重症监护病房（PICU）、儿科心胸重症监护病房（PCTU）和新生儿重症监护病房（NICU）患者与入住这些病房的所有其他患者之间是否存在社会人口学差异，如种族和社会经济地位，并描述这一背景下确定的主要伦理问题。
我们比较了 2017 年 1 月至 2018 年 12 月期间入住一家四级学术儿童医院的患者的社会人口学因素，这些患者在 PICU、PCTU 和 NICU 跨专业伦理查房中被确定存在伦理问题（n=122）与入住这些病房的所有其他患者（n=4971）。采用 χ2 检验或 Fisher 确切检验、Mann-Whitney U 检验和多变量逻辑回归分析。
在单变量分析中，我们根据种族、保险类型和呼吸机依赖程度发现了显著差异，但在性别、种族、宗教、主要语言、年龄或社会经济地位指标方面，两组之间没有显著差异。在用多变量逻辑回归分析调整混杂因素后，只有呼吸机依赖的患者被确定存在伦理问题的可能性显著更高（比值比=5.78；95%置信区间=3.69-9.04；<0.001）。关注治疗目标是最常见的伦理问题（44%）。
除了呼吸机依赖，在 PICU、PCTU 和 NICU 跨专业伦理查房中确定存在伦理问题的患者在人口统计学上与入住这些病房的所有其他患者相似。未来的研究应评估主动查房是否会影响伦理咨询请求的时间，以及跨专业伦理查房是否会影响正式伦理咨询实践的数量和严重程度。
