Sridharan Govind, Fleury Yvan, Hergafi Leila, Doll Sébastien, Ksouri Hatem
Department of Intensive Care Medicine, Fribourg Hospital, CH-1700 Fribourg, Switzerland.
J Clin Med. 2023 Aug 25;12(17):5513. doi: 10.3390/jcm12175513.
The appropriate selection of patients for the intensive care unit (ICU) is a concern in acute care settings. However, the description of patients deemed too well for the ICU has been rarely reported.
We conducted a single-centre retrospective observational study of all patients either deemed "too well" for or admitted to the ICU during one year. Refused patients were screened for unexpected events within 7 days, defined as either ICU admission without another indication, or death without treatment limitations. Patients' characteristics and organisational factors were analysed according to refusal status, outcome and delay in ICU admission.
Among 2219 enrolled patients, the refusal rate was 10.4%. Refusal was associated with diagnostic groups, treatment limitations, patients' location on a ward, night time and ICU occupancy. Unexpected events occurred in 16 (6.9%) refused patients. A worse outcome was associated with time spent in hospital before refusal, patients' location on a ward, SOFA score and physician's expertise. Delayed ICU admissions were associated with ICU and hospital length of stay.
ICU triage selected safely most patients who would have probably not benefited from the ICU. We identified individual and organisational factors associated with ICU refusal, subsequent ICU admission or death.
在急性护理环境中，重症监护病房（ICU）患者的合理选择是一个备受关注的问题。然而，关于被认为病情过轻而不适宜入住ICU的患者的描述却鲜有报道。
我们对一年内所有被认为“病情过轻”而不适宜入住ICU或入住ICU的患者进行了一项单中心回顾性观察研究。对拒绝入住的患者在7天内筛查意外事件，意外事件定义为无其他指征而入住ICU或未经治疗限制而死亡。根据拒绝状态、结局和入住ICU的延迟时间对患者特征和组织因素进行分析。
在2219名登记患者中，拒绝率为10.4%。拒绝与诊断组、治疗限制、患者在病房的位置、夜间及ICU床位占用情况有关。16名（6.9%）拒绝入住的患者发生了意外事件。较差的结局与拒绝前住院时间、患者在病房的位置、序贯器官衰竭评估（SOFA）评分及医生专业知识有关。延迟入住ICU与ICU住院时间和医院住院时间有关。
ICU分诊安全地筛选出了大多数可能无法从ICU治疗中获益的患者。我们确定了与ICU拒绝、随后的ICU入住或死亡相关的个体和组织因素。
