Department of Anesthesia and Critical Care Medicine, Odense University Hospital, Svendborg, Denmark.
Department of Anesthesia and Critical Care Medicine, Hospital Sønderjylland, Aabenraa, Denmark.
BMC Geriatr. 2024 Oct 21;24(1):853. doi: 10.1186/s12877-024-05452-w.
Life-sustaining therapy, including heart and lung resuscitation and transfer to the intensive care department, is demanding for patients and relatives and utilizes large amounts of healthcare resources. For older patients acutely admitted to the hospital, very sparse data exist on decision making about life-sustaining therapy.
Retrospective data were extracted from patients ≥ 70 years old who were acutely admitted to the hospital. Age, sex, clinical frailty scale score and Charlson comorbidity index were manually extracted from patients' files. Furthermore, data about life-sustaining treatment decisions were extracted. This was further divided into decisions documented within 24 h from admission or during the hospital stay.
Data were extracted for 200 patients with a median age of 80 years. Patients had a Charlson Comorbidity Index of 6 (5-8 IQR) and a Clinical Frailty Scale (CFS) score of 5 (3-6 IQR). During the first 24 h, 61 patients (30.5%) had a written decision about heart and cardiopulmonary resuscitation (CPR), and 52 patients (26%) had written information about intensive care therapy. A total of 93 patients (46.5%) had a written decision about cardiopulmonary resuscitation (CPR), intensive care therapy or both during their hospital stay. With increasing Charlson Comorbidity Index and Clinical Frailty Scale scores, more patients had decisions about limitations in therapy documented in their files.
Within the first 24 h, 30.5% of the patients had a written decision about cardiopulmonary resuscitation (CPR), and 26% had written information about intensive care therapy. These numbers increased to 46.5% of patients who had a decision made during their hospital stay whether they were candidates for either cardiopulmonary resuscitation (CPR), intensive care therapy or both. These data suggest that further work should be done to determine the limitations of therapy early on the admission for all older frail acutely admitted patients.
生命维持治疗，包括心肺复苏和转入重症监护病房，对患者和家属来说要求很高，并且会消耗大量的医疗资源。对于急性住院的老年患者，关于生命维持治疗的决策非常少。
从急性住院的年龄≥70 岁的患者中提取回顾性数据。从患者的病历中手动提取年龄、性别、临床虚弱量表评分和 Charlson 合并症指数。此外，还提取了关于生命维持治疗决策的数据。这进一步分为入院后 24 小时内或住院期间记录的决策。
共提取了 200 名中位年龄为 80 岁的患者的数据。患者的 Charlson 合并症指数为 6（5-8 IQR），临床虚弱量表（CFS）评分为 5（3-6 IQR）。在最初的 24 小时内，61 名患者（30.5%）有书面的心肺复苏（CPR）决策，52 名患者（26%）有书面的重症监护治疗信息。共有 93 名患者（46.5%）在住院期间有书面的心肺复苏（CPR）、重症监护治疗或两者的治疗限制决策。随着 Charlson 合并症指数和临床虚弱量表评分的增加，更多的患者在病历中记录了治疗限制的决策。
在最初的 24 小时内，30.5%的患者有书面的心肺复苏（CPR）决策，26%的患者有书面的重症监护治疗信息。这些数字在住院期间增加到 46.5%的患者，他们是否是心肺复苏（CPR）、重症监护治疗或两者的候选者都有决定。这些数据表明，对于所有急性入院的体弱老年患者，应进一步努力尽早确定治疗的限制。
