Chen Pei-Yun, Huang Chien-Hsun, Peng Jen-Kuei, Yeh Shin-Yu, Hung Shou-Hung
Department of Family Medicine, 210835National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan.
Department of Family Medicine, 38006National Taiwan University Hospital, Taipei, Taiwan.
Am J Hosp Palliat Care. 2023 Apr;40(4):440-446. doi: 10.1177/10499091221108507. Epub 2022 Jun 14.
Previous reports suggested the clinical predictions of survival (CPS) and prognostic scores had similar accuracy in patients with days to weeks of life. We aimed to evaluate and compare the accuracy of CPS by attending physicians, residents, and nurses in an acute palliative care unit at a medical center. Methods: This was a 1-year prospective cohort study. Survival prediction was made within 3 days after patients' admission and re-evaluated every week until patients' discharge or death. Associated factors of accurate survival predictions were also explored by multivariate logistic regression. A total of 179 inpatients were recruited and 115 of them were included in this analysis. The mean age of participants was 72.9 years and the average length of actual survival was 11.5 ± 12.0 days. For patients with survival within 30 days, the medical staff tended to overestimate their life span. The predictions made by physicians and nurses showed much closer to actual survival length through repeated estimations. Patients with metastatic cancer (odds ratio: OR 2.77, 95% CI 1.23-6.22) or cognitive impairment (OR 2.39, 95% CI 1.12-5.11) had higher associations with accurate CPS. Poor performance status of ECOG (OR 1.82, 95% CI 1.09-3.02) and dysphagia (OR 2.01, 95% CI 1.07-3.77) were significant predictors for accurate CPS in patients with the survival of less than 2 weeks. The accuracy of CPS between different medical staff did not reveal significant differences in the study. The importance of re-evaluation for patients' survival length in clinical practice is worthy of attention.
先前的报告表明，在生存期为数天至数周的患者中，临床生存预测（CPS）和预后评分的准确性相似。我们旨在评估并比较医疗中心急性姑息治疗病房的主治医师、住院医师和护士进行CPS的准确性。方法：这是一项为期1年的前瞻性队列研究。在患者入院后3天内进行生存预测，并每周重新评估一次，直至患者出院或死亡。还通过多因素逻辑回归探讨了准确生存预测的相关因素。共招募了179名住院患者，其中115名纳入本分析。参与者的平均年龄为72.9岁，实际生存的平均时长为11.5±12.0天。对于生存期在30天内的患者，医护人员往往高估了他们的寿命。通过反复评估，医师和护士所做的预测更接近实际生存时长。发生转移癌（比值比：OR 2.77，95%置信区间1.23 - 6.22）或存在认知障碍（OR 2.39，95%置信区间1.12 - 5.11）的患者与准确的CPS关联度更高。对于生存期少于2周的患者，ECOG体能状态差（OR 1.82，95%置信区间1.09 - 3.02）和吞咽困难（OR 2.01，95%置信区间1.07 - 3.77）是准确CPS的显著预测因素。在本研究中，不同医护人员之间CPS的准确性未显示出显著差异。临床实践中对患者生存时长进行重新评估的重要性值得关注。
