Idzwan Zakaria Mohd, Che Manshor Norhadila, Maw Pin Tan
Academic Trauma and Emergency Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Geriatric Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Arch Acad Emerg Med. 2023 Jan 3;11(1):e16. doi: 10.22037/aaem.v11i1.1613. eCollection 2023.
A decision-making guideline on when to intubate an older person based on predictors of intubation outcome would be extremely beneficial. This study aimed to identify the associated factors that could predict the outcomes of endotracheal intubation among older adults in the Emergency Department (ED).
In this retrospective cross-sectional study, patients aged ≥65 years intubated at the ED of University of Malaya Medical Centre, Kuala Lumpur, Malaysia, from 2015 to 2019 were studied. The association between age, gender, place of inhabitation, Identification of Seniors at Risk (ISAR) score for frailty, Charlson Comorbidity Index (CCI), Acute Physiology and Chronic Health Evaluation-II (APACHE-II) score, indication for intubation, and diagnosis on admission with in-hospital mortality (primary outcome) and duration of ventilation, and length of stay (secondary outcomes) were evaluated using univariate analysis and Cox's regression survival analysis.
889 cases aged 65 years and above were studied (61.5% male). The rate of in-hospital mortality was 71.4%. There was a significant association between age (p < 0.001), nursing home residency (p = 0.008), CCI≥ 5 (p = 0.001), APACHE-II (p < 0.001), pre-intubation Glasgow Coma Scale (GCS) (p < 0.001), cardiac arrest as indication of intubation (p < 0.001), diagnosis on admission (p < 0.001), length of stay (p < 0.001), and length of ventilation (p = 0.003) and in-hospital mortality. Age ≥ 85 years (HR= 1.270; 95%CI=1.074 to 1.502) and 75 to 84 years (HR=1.642; 95%CI=1.167 to 2.076), cardiac arrest as indication of intubation (HR: 1.882; 95% CI: 1.554 - 2.279), and APACHE-II scores 25 - 34 (HR: 1.423; 95% CI: 1.171 - 1.730) and ≥ 35 (HR: 1.789; 95%CI: 1.418 - 2.256) were amongst the independent predictive factors of in-hospital mortality.
Nearly three out of four individuals aged ≥65 years intubated at the ED died during the same admission. Older age, cardiac arrest as indication of intubation, and APACHE-II score were independent predictors of in-hospital mortality.
基于插管结果预测因素制定的关于何时对老年人进行插管的决策指南将非常有益。本研究旨在确定急诊科（ED）中可预测老年成人气管插管结果的相关因素。
在这项回顾性横断面研究中，对2015年至2019年在马来西亚吉隆坡马来亚大学医学中心急诊科接受插管的年龄≥65岁的患者进行了研究。使用单因素分析和Cox回归生存分析评估年龄、性别、居住地点、脆弱性风险老年人识别（ISAR）评分、Charlson合并症指数（CCI）、急性生理学和慢性健康评估-II（APACHE-II）评分、插管指征以及入院诊断与院内死亡率（主要结局）、通气时间和住院时间（次要结局）之间的关联。
共研究了889例65岁及以上的病例（男性占61.5%）。院内死亡率为71.4%。年龄（p<0.001）、居住在养老院（p = 0.008）、CCI≥5（p = 0.001）、APACHE-II（p<0.001）、插管前格拉斯哥昏迷量表（GCS）（p<0.001）、以心脏骤停作为插管指征（p<0.001）、入院诊断（p<0.001）、住院时间（p<0.001）和通气时间（p = 0.003）与院内死亡率之间存在显著关联。年龄≥8岁（HR = 1.270；95%CI = 1.074至1.502）以及75至84岁（HR = 1.642；95%CI = 1.167至2.076）、以心脏骤停作为插管指征（HR：1.882；95%CI：1.554 - 2.279）以及APACHE-II评分为25 - 34（HR：1.423；95%CI：1.171 - 1.730）和≥35（HR：1.789；95%CI：1.418 - 2.256）是院内死亡率的独立预测因素。
在急诊科接受插管的6岁及以上患者中，近四分之三在同一次住院期间死亡。高龄、以心脏骤停作为插管指征以及APACHE-II评分是院内死亡率的独立预测因素。
