Guion Vincent, Sabra Ayman, Martin Catherine, Blanc Emmanuelle, De Souto Barreto Philipe, Rolland Yves
Gerontopole of Toulouse, Institute on Aging, Toulouse University Hospital (CHU Toulouse), Toulouse, France; Service de soins palliatifs, CHU de Besançon, Besançon, France.
Direction Médicale Vaccins, Pfizer France, Paris, France.
J Am Med Dir Assoc. 2023 May;24(5):747-752. doi: 10.1016/j.jamda.2023.02.108. Epub 2023 Mar 27.
To describe nursing home residents (NHRs) transferred to the emergency department (ED) with pneumonia, and investigate the association of pneumonia with functional ability and mortality.
Case-control observational multicenter study.
Participants of the FINE study, including 1037 NHRs presenting to 17 EDs in France over 4 nonconsecutive weeks (1 per season) in 2016, mean age 87.2 years ± 7.1, 68.4% women.
Activities of daily living (ADL) performance evolution between (1) 15 days before transfer and (2) within 7 days after discharge back to the nursing home was compared in NHRs with or without pneumonia. The association of pneumonia with functional evolution was investigated by a mixed-effect linear regression of ADL and mortality was compared by a χ test.
NHRs with pneumonia (n = 232; 22.4%) were more likely to have a lower ADL performance than NHRs without pneumonia (n = 805, 77.6%). They presented with a more severe clinical condition, were more likely to be hospitalized after ED and to stay longer in ED and in hospital. They showed a 0.5 decline in median ADL performance after transfer and a significantly higher mortality than NHRs without pneumonia (24.1% and 8.7%, respectively). Post-ED functional evolution did not differ significantly between NHRs with or without pneumonia.
Pneumonia-associated ED transfers resulted in longer care pathways and higher mortality, but no significant difference in functional decline. This study identified a suggestive course of symptoms that could facilitate early identification of NHRs developing pneumonia and early management to prevent ED transfer.
描述因肺炎转入急诊科（ED）的疗养院居民（NHRs），并调查肺炎与功能能力及死亡率之间的关联。
病例对照观察性多中心研究。
FINE研究的参与者，包括2016年法国17家急诊科在4个非连续周（每个季节1周）接待的1037名NHRs，平均年龄87.2岁±7.1岁，女性占68.4%。
比较有或无肺炎的NHRs在（1）转院前15天和（2）转回疗养院后7天内日常生活活动（ADL）表现的变化。通过ADL的混合效应线性回归研究肺炎与功能演变的关联，并通过χ检验比较死亡率。
患有肺炎的NHRs（n = 232；22.4%）比未患肺炎的NHRs（n = 805，77.6%）更有可能具有较低的ADL表现。他们的临床状况更严重，在急诊科就诊后更有可能住院，且在急诊科和医院停留的时间更长。转院后，他们的ADL表现中位数下降了0.5，死亡率显著高于未患肺炎的NHRs（分别为24.1%和8.7%）。有或无肺炎的NHRs在急诊科后的功能演变没有显著差异。
与肺炎相关的急诊科转运会导致更长的护理路径和更高的死亡率，但在功能衰退方面没有显著差异。本研究确定了一个提示性的症状过程，可有助于早期识别患肺炎的NHRs并进行早期管理以防止转入急诊科。
