Kopecky E A, Jacobson S, Joshi P, Martin M, Koren G
Department of Paediatrics, Hospital for Sick Children, Faculty of Pharmacy, University of Toronto, Ontario, Canada.
J Palliat Care. 1997 Winter;13(4):28-33.
This retrospective chart review presents the patient characteristics and utilization of the home-based palliative care program at The Hospital for Sick Children in Toronto. A total of 126 children dying from a broad spectrum of diseases was admitted during the period 1986-1994, referred from neurosurgery, genetic/metabolic, neurology, neonatology, nephrology, cardiology, general pediatrics, general surgery, and pulmonology. At the time of review, 15 patients remained alive and 18 had been discharged from the program. Mean age at the time of referral was 4.8 +/- 0.51 years and mean age at death was 5.3 +/- 0.55 years. The mean number of days in hospital was 26.5 +/- 14.6 while days spent at home averaged 98.4 +/- 15.2; thus 80% of the children's remaining time was spent at home. The average number of parent-team contacts was 3.5 +/- 0.9 by pager and 24.0 +/- 2.9 by telephone. Of the 93 patients who died in the program, 53% died at home, 18% died in community hospitals, and 29% died in a tertiary care facility. Analgesic medications were administered to 54% of the patients; 56% of these then required opioid analgesia for pain and symptom management. Home-based palliative care appeared to be an effective program for many children with a variety of terminal illnesses after adequate supports for the child and family had been established.
本回顾性图表审查展示了多伦多病童医院家庭姑息治疗项目的患者特征及使用情况。1986年至1994年期间，共有126名因多种疾病濒临死亡的儿童入院，他们分别来自神经外科、遗传/代谢科、神经科、新生儿科、肾科、心脏科、普通儿科、普通外科和肺科。在审查时，15名患者仍在世，18名患者已从该项目出院。转诊时的平均年龄为4.8±0.51岁，死亡时的平均年龄为5.3±0.55岁。平均住院天数为26.5±14.6天，而在家的天数平均为98.4±15.2天；因此，这些儿童剩余时间的80%是在家中度过的。家长与团队通过传呼机联系的平均次数为3.5±0.9次，通过电话联系的平均次数为24.0±2.9次。在该项目中死亡的93名患者中，53%在家中死亡，18%在社区医院死亡，29%在三级医疗机构死亡。54%的患者接受了止痛药物治疗；其中56%随后需要使用阿片类镇痛药来控制疼痛和症状。在为儿童及其家庭提供了充分支持后，家庭姑息治疗似乎对许多患有各种晚期疾病的儿童是一个有效的项目。
