School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Palliative Care Service, Alfred Health, Melbourne, Victoria, Australia.
J Burn Care Res. 2023 May 2;44(3):675-684. doi: 10.1093/jbcr/irac017.
Whilst burn-related mortality is rare in high-income countries, there are unique features related to prognostication that make examination of decision-making practices important to explore. Compared to other kinds of trauma, burn patients (even those with nonsurvivable injuries) may be relatively stable after injury initially. Complications or patient comorbidity may make it clear later in the clinical trajectory that ongoing treatment is futile. Burn care clinicians are therefore required to make decisions regarding the withholding or withdrawal of treatment in patients with potentially nonsurvivable burn injury. There is yet to be a comprehensive investigation of treatment decision practices following burn injury in Australia and New Zealand. Data for patients admitted to specialist burn services between July 2009 and June 2020 were obtained from the Burns Registry of Australia and New Zealand. Patients were grouped according to treatment decision: palliative management, active treatment withdrawn, and active treatment until death. Predictors of treatment initiation and withholding or withdrawing treatment within 24 hours were assessed using multilevel mixed-effects logistic regression. Descriptive comparisons between treatment groups were made. Of the 32,186 patients meeting study inclusion criteria, 327 (1.0%) died prior to discharge. Fifty-six patients were treated initially with palliative intent and 227 patients had active treatment initiated and later withdrawn. Increasing age and burn size reduced the odds of having active treatment initiated. We demonstrate differences in demographic and injury severity characteristics as well as end of life decision-making timing between different treatment pathways pursued for patients who die in-hospital. Our next step into the decision-making process is to gain a greater understanding of the clinician's perspective (eg, through surveys and/or interviews).
虽然在高收入国家，烧伤相关死亡率较低，但由于预后判断存在一些独特特征，因此研究决策实践对于探索该问题很重要。与其他类型的创伤相比，烧伤患者（即使是那些伤势无法治愈的患者）在受伤初始阶段可能相对稳定。但并发症或患者合并症可能会在临床病程后期清楚表明，持续治疗是徒劳的。因此，烧伤护理临床医生需要在可能无法治愈烧伤的患者中决定是否停止或停止治疗。目前尚未对澳大利亚和新西兰的烧伤后治疗决策实践进行全面调查。本研究从澳大利亚和新西兰烧伤登记处获得了 2009 年 7 月至 2020 年 6 月期间入住专科烧伤服务的患者数据。根据治疗决策将患者分组：姑息治疗、主动治疗停止和主动治疗直至死亡。使用多级混合效应逻辑回归评估 24 小时内开始治疗和停止或停止治疗的预测因素。对治疗组之间进行了描述性比较。在符合研究纳入标准的 32186 名患者中，有 327 名（1.0%）在出院前死亡。56 名患者最初接受姑息治疗，227 名患者开始积极治疗，然后停止治疗。年龄增长和烧伤面积增加会降低开始积极治疗的可能性。我们展示了在住院期间死亡的患者中，不同治疗途径的人口统计学和损伤严重程度特征以及临终决策时间的差异。我们下一步是更深入地了解临床医生的观点（例如，通过调查和/或访谈）。
