Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Public Healthcare Center, Seoul National University Hospital, Seoul, Korea.
BMC Palliat Care. 2022 Jun 7;21(1):105. doi: 10.1186/s12904-022-00988-3.
High-quality end-of-life (EOL) care requires both comfort care and the maintenance of dignity. However, delivering EOL in the emergency department (ED) is often challenging. Therefore, we aimed to investigate characteristics of EOL care for dying patients in the ED.
We conducted a retrospective cohort study of patients who died of disease in the ED at a tertiary hospital in Korea between January 2018 and December 2020. We examined medical care within the last 24 h of life and advance care planning (ACP) status.
Of all 222 disease-related mortalities, 140 (63.1%) were men, while 141 (63.5%) had cancer. The median age was 74 years. As for critical care, 61 (27.5%) patients received cardiopulmonary resuscitation, while 80 (36.0%) received mechanical ventilation. The absence of serious illness (p = 0.011) and the lack of an advance statement (p < 0.001) were both independently associated with the receipt of more critical care. Only 70 (31.5%) patients received comfort care through opioids. Younger patients (< 75 years) (p = 0.002) and those who completed life-sustaining treatment legal forms (p = 0.001) received more comfort care. While EOL discussions were initiated in 150 (67.6%) cases, the palliative care team was involved only in 29 (13.1%).
Patients in the ED underwent more aggressive care and less comfort care in a state of imminent death. To ensure better EOL care, physicians should minimize redundant evaluations and promptly introduce ACP.
高质量的临终关怀（EOL）需要舒适护理和尊严维护。然而，在急诊科（ED）提供 EOL 往往具有挑战性。因此，我们旨在调查 ED 临终患者的 EOL 护理特点。
我们对韩国一家三级医院 2018 年 1 月至 2020 年 12 月期间因疾病在 ED 死亡的患者进行了回顾性队列研究。我们检查了生命最后 24 小时内的医疗护理和预先护理计划（ACP）状况。
在所有 222 例与疾病相关的死亡中，140 例（63.1%）为男性，141 例（63.5%）患有癌症。中位年龄为 74 岁。在重症监护方面，61 例（27.5%）患者接受心肺复苏，80 例（36.0%）患者接受机械通气。无严重疾病（p=0.011）和缺乏预先声明（p<0.001）均与接受更多重症监护独立相关。只有 70 例（31.5%）患者通过阿片类药物接受舒适护理。较年轻的患者（<75 岁）（p=0.002）和完成生命维持治疗法律表格的患者（p=0.001）接受了更多的舒适护理。虽然在 150 例（67.6%）病例中启动了 EOL 讨论，但只有 29 例（13.1%）涉及姑息治疗团队。
在即将死亡的状态下，ED 中的患者接受了更积极的治疗和较少的舒适护理。为了确保更好的 EOL 护理，医生应尽量减少多余的评估，并及时引入 ACP。
