Gray Tamryn F, Kwok Anne, Do Khuyen M, Zeng Sandra, Moseley Edward T, Dbeis Yasser M, Umeton Renato, Tulsky James A, El-Jawahri Areej, Lindvall Charlotta
Department of Medicine, Harvard Medical School, Boston, MA, United States.
Division of Palliative Medicine, Brigham and Women's Hospital, Boston, MA, United States.
JMIR Med Inform. 2022 Jun 15;10(6):e33921. doi: 10.2196/33921.
Little is known about family member involvement, by relationship status, for patients treated in the intensive care unit (ICU).
Using documentation of family interactions in clinical notes, we examined associations between child and spousal involvement and ICU patient outcomes, including goals of care conversations (GOCCs), limitations in life-sustaining therapy (LLST), and 3-month mortality.
Using a retrospective cohort design, the study included a total of 858 adult patients treated between 2008 and 2012 in the medical ICU at a tertiary care center in northeastern United States. Clinical notes generated within the first 48 hours of admission to the ICU were used with standard machine learning methods to predict patient outcomes. We used natural language processing methods to identify family-related documentation and abstracted sociodemographic and clinical characteristics of the patients from the medical record.
Most of the 858 patients were White (n=650, 75.8%); 437 (50.9%) were male, 479 (55.8%) were married, and the median age was 68.4 (IQR 56.5-79.4) years. Most patients had documented GOCC (n=651, 75.9%). In adjusted regression analyses, child involvement (odds ratio [OR] 0.81; 95% CI 0.49-1.34; P=.41) and child plus spouse involvement (OR 1.28; 95% CI 0.8-2.03; P=.3) were not associated with GOCCs compared to spouse involvement. Child involvement was not associated with LLST when compared to spouse involvement (OR 1.49; 95% CI 0.89-2.52; P=.13). However, child plus spouse involvement was associated with LLST (OR 1.6; 95% CI 1.02-2.52; P=.04). Compared to spouse involvement, there were no significant differences in the 3-month mortality by family member type, including child plus spouse involvement (OR 1.38; 95% CI 0.91-2.09; P=.13) and child involvement (OR 1.47; 95% CI 0.9-2.41; P=.12).
Our findings demonstrate that statistical models derived from text analysis in the first 48 hours of ICU admission can predict patient outcomes. Early child plus spouse involvement was associated with LLST, suggesting that decisions about LLST were more likely to occur when the child and spouse were both involved compared to the involvement of only the spouse. More research is needed to further understand the involvement of different family members in ICU care and its association with patient outcomes.
对于在重症监护病房（ICU）接受治疗的患者，按亲属关系状况划分的家庭成员参与情况鲜为人知。
利用临床记录中家庭互动的文档，我们研究了子女和配偶参与情况与ICU患者结局之间的关联，包括医疗照护目标谈话（GOCCs）、维持生命治疗的限制（LLST）以及3个月死亡率。
采用回顾性队列设计，该研究共纳入了2008年至2012年期间在美国东北部一家三级医疗中心的内科ICU接受治疗的858例成年患者。使用标准机器学习方法，将ICU入院后最初48小时内生成的临床记录用于预测患者结局。我们运用自然语言处理方法识别与家庭相关的文档，并从病历中提取患者的社会人口学和临床特征。
858例患者中大多数为白人（n = 650，75.8%）；437例（50.9%）为男性，479例（55.8%）已婚，年龄中位数为68.4（四分位间距56.5 - 79.4）岁。大多数患者有记录的GOCC（n = 651，75.9%）。在调整后的回归分析中，与配偶参与相比，子女参与（优势比[OR] 0.81；95%置信区间0.49 - 1.34；P = 0.41）以及子女加配偶参与（OR 1.28；95%置信区间0.8 - 2.03；P = 0.3）与GOCCs无关。与配偶参与相比，子女参与与LLST无关（OR 1.49；95%置信区间0.89 - 2.52；P = 0.13）。然而，子女加配偶参与与LLST相关（OR 1.6；95%置信区间1.02 - 2.52；P = 0.04）。与配偶参与相比，按家庭成员类型划分的3个月死亡率无显著差异，包括子女加配偶参与（OR 1.38；95%置信区间0.91 - 2.09；P = 0.13）和子女参与（OR 1.47；95%置信区间0.9 - 2.41；P = 0.12）。
我们的研究结果表明，在ICU入院最初48小时内通过文本分析得出的统计模型可以预测患者结局。早期子女加配偶参与与LLST相关，这表明与仅配偶参与相比，当子女和配偶都参与时，关于LLST的决策更有可能发生。需要更多研究来进一步了解不同家庭成员在ICU护理中的参与情况及其与患者结局的关联。
