Sachdeva R C, Jefferson L S, Coss-Bu J, Brody B A
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
J Pediatr. 1996 Jun;128(6):742-7. doi: 10.1016/s0022-3476(96)70323-2.
To estimate resource consumption and the extent of futile care among patients admitted to the pediatric intensive care unit (PICU).
A prospective cohort study of 353 consecutive admissions followed for 1334 patient-days during the PICU stay at the Texas Children's Hospital in Houston, Texas. Participants were 353 children and adolescents who were hospitalized in the PICU during September and October 1993. Three broad operational definitions of futility were developed to capture the maximum extent of resource consumption related to medical futility. Definition 1 (imminent demise futility) was developed by an objective, validated, severity of illness measure (Pediatric Risk of Mortality Score) to identify patients with high mortality risks. Definition 2 (lethal condition futility) was used to identify patients in the PICU whose long-term survival was unlikely. Definition 3 (qualitative futility) was used to identify patients with high morbidity. Resource consumption was measured according to the number of patient-days in the PICU and the Therapeutic Intervention Scoring System.
Twenty-three (6.5%) patients representing 36 (2.7%) patient-days met at least one of the definitions of medical futility for some of the days when they were in the PICU. None of the patient-days that met any of the definitions of medical futility were associated with high resource consumption compared with non-futile care patient-days.
Despite our use of broad definitions of medical futility, relatively small amounts of resources were used in futile PICU care. This suggests that attempts to reduce resource consumption in the PICU by focusing on medical futility are unlikely to be successful.
评估入住儿科重症监护病房（PICU）患者的资源消耗及无效治疗的程度。
一项前瞻性队列研究，对德克萨斯州休斯顿市德克萨斯儿童医院PICU连续收治的353例患者进行了为期1334个患者日的随访。研究对象为1993年9月和10月在PICU住院的353名儿童和青少年。制定了三种宽泛的无效操作定义，以涵盖与医疗无效相关的最大资源消耗范围。定义1（即将死亡的无效性）是通过一种客观、经过验证的疾病严重程度测量方法（儿科死亡风险评分）来确定具有高死亡风险的患者。定义2（致命状况无效性）用于识别PICU中不太可能长期存活的患者。定义3（定性无效性）用于识别高发病率患者。根据PICU的患者日数和治疗干预评分系统来衡量资源消耗。
23名（6.5%）患者，共36个（2.7%）患者日，在其入住PICU的某些日子里符合至少一项医疗无效定义。与非无效治疗的患者日相比，符合任何医疗无效定义的患者日均未出现高资源消耗情况。
尽管我们使用了宽泛的医疗无效定义，但在PICU的无效治疗中使用的资源相对较少。这表明，试图通过关注医疗无效来减少PICU的资源消耗不太可能成功。
