姑息治疗与快速紧急筛查（P-CaRES）工具、广泛和狭义标准以及意外问题在预测老年急诊科患者生存方面的比较。
A comparison of palliative care and rapid emergency screening (P-CaRES) tool, broad and narrow criteria, and surprise questions to predict survival of older emergency department patients.
机构信息
Emergency department, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Emergency department, Massachusetts General Hospital, Boston, USA.
出版信息
BMC Palliat Care. 2023 Jun 27;22(1):81. doi: 10.1186/s12904-023-01205-5.
BACKGROUND
Palliative care is a form of medical care designed to enhance the quality of life of patients with life-threatening conditions. This study was conducted to compare the accuracy of predicted survival the 1 and 3-month survival rate of Broad and narrow criteria, Surprise questions (SQ), and Palliative Care and Rapid Emergency Screening (P-CaRES) after admission to the emergency department (ED).
METHODS
This prospective cohort study was conducted at an urban teaching hospital in Thailand. Patients aged ≥ 65 years admitted to the ED were classified according to their emergency severity index (ESI) (Level: 1-3). We collected data on SQ, P-CaRES, and broad and narrow criteria. A survival data of participants were collected at 1 and 3 months after admission to the ED. The survival rate was calculated using the Kaplan-Meier and log-rank tests.
RESULTS
A total of 269 patients completed the study. P-CaRES positive and P-CaRES negative patients had 1-month survival rates of 81% and 94.8%, respectively (P = 0.37), and at 3-month survival rates of 70.7% and 90.1%, respectively (P < 0.001). SQ (not surprised) had a 1-month survival rate of 79.3%, while SQ (surprised) had a 97% survival rate (P = 0.01), and SQ (not surprised) had a 75.4% survival rate at 3-months, while SQ (surprised) had a 96.3% survival rate (P = 0.01). Broad and narrow criteria that were positive and negative had 1-month survival rates of 88.1% and 92.5%, respectively (P = 0.71), while those that were positive and negative had 3-month survival rates of 78.6% and 87.2%, respectively (P = 0.19). The hazard ratio (HR) of SQ (not surprised) at 1 month was 3.22( 95%CI:1.16-8.89). The HR at 3 months of P-CaRES (positive) was 3.31 with a 95% confidence interval (CI): 1.74 - 6.27, while the HR for SQ (not surprise) was 7.33, 95% CI: 3.03-19.79; however, broad and narrow criteria had an HR of 1.78, 95% CI:0.84-3.77.
CONCLUSIONS
Among older adults who visited the ED, the SQ were good prognosis tools for predicting 1 and 3-month survival, and P-CaRES were good prognostic tools for predicting 3-month survival.
背景
姑息治疗是一种旨在提高危及生命的疾病患者生活质量的医疗形式。本研究旨在比较入院后宽和窄标准、意外问题 (SQ)、姑息治疗和快速紧急筛查 (P-CaRES) 对 1 个月和 3 个月生存率的预测准确性。
方法
这是一项在泰国城市教学医院进行的前瞻性队列研究。根据急诊严重指数 (ESI)（级别：1-3）将年龄≥65 岁的患者分为入院的 ED。我们收集了 SQ、P-CaRES 和宽和窄标准的数据。在 ED 入院后 1 个月和 3 个月收集参与者的生存数据。使用 Kaplan-Meier 和对数秩检验计算生存率。
结果
共有 269 名患者完成了这项研究。P-CaRES 阳性和 P-CaRES 阴性患者的 1 个月生存率分别为 81%和 94.8%（P=0.37），3 个月生存率分别为 70.7%和 90.1%（P<0.001）。SQ（不惊讶）的 1 个月生存率为 79.3%，而 SQ（惊讶）的生存率为 97%（P=0.01），SQ（不惊讶）的 3 个月生存率为 75.4%，而 SQ（惊讶）的生存率为 96.3%（P=0.01）。宽和窄标准阳性和阴性的 1 个月生存率分别为 88.1%和 92.5%（P=0.71），而阳性和阴性的 3 个月生存率分别为 78.6%和 87.2%（P=0.19）。SQ（不惊讶）的 1 个月 HR 为 3.22（95%CI：1.16-8.89）。P-CaRES（阳性）的 3 个月 HR 为 3.31，95%CI：1.74-6.27，而 SQ（不惊讶）的 HR 为 7.33，95%CI：3.03-19.79；然而，宽和窄标准的 HR 为 1.78，95%CI：0.84-3.77。
结论
在就诊 ED 的老年人中，SQ 是预测 1 个月和 3 个月生存率的良好预后工具，而 P-CaRES 是预测 3 个月生存率的良好预后工具。
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