Palliative Care Consultation in Hospitalized Patients With COVID-19: A Retrospective Study of Characteristics, Outcomes, and Unmet Needs.
Palliative Care Consultation in Hospitalized Patients With COVID-19: A Retrospective Study of Characteristics, Outcomes, and Unmet Needs.
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DOI：
10.1016/j.jpainsymman.2020.12.015
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发表时间：
2021-08
影响因子：
4.7
通讯作者：
Burns EA
中科院分区：
文献类型：
--
作者：
Lopez S;Finuf KD;Marziliano A;Sinvani L;Burns EA
很少有研究描述2019冠状病毒病（COVID-19）住院患者的特征和姑息治疗需求。描述接受姑息治疗评估的COVID-19住院患者的特征、咨询需求、患者需求和结果。2020年3月1日至5月11日期间，老年病和姑息医学团队对一家学术四级中心收治的COVID-19患者（年龄18岁以上）进行了回顾性病历审查。分析了社会人口统计学、操作指标、疾病严重程度、护理目标-高级护理计划文件和结局。在2138名COVID-19入院者中，有376名（17.6%）是咨询团队看到的。与疫情前（2019年9月1日至2020年2月29日）相比，总体新咨询（205 vs. 371，P < 0.001）显著增加，特别是在重症监护室（ICU; 9.5% vs. 36.9%，P < 0.001）。对于COVID-19人群，中位年龄为78岁（四分位数范围，70-87;范围，36-102）; 56%为男性。LACE评分、D-二聚体和C-反应蛋白提示病情严重，死亡风险增加。75%的咨询是为了护理高级护理计划的目标，9.6%是为了症状。在索引入院期间，7.1%记录了预先指令，69.7%成为不复苏。在所有死亡中，55.5%在ICU，87.2%年龄≥65岁。服务不足的少数民族患者的死亡率不成比例。与COVID-19之前相比，总体会诊死亡率（38.3% vs. 70.4%，P < 0.001）和ICU死亡率（55.2% vs. 78.1%，P < 0.001）显著增加。在这场大流行期间，了解住院患者的专门姑息治疗需求和导致这些原因的弱势人群可能会鼓励卫生保健机构和地方、州和联邦政府支持专门的姑息治疗工作人员。
Few studies have described the characteristics and palliative care needs in hospitalized patients with coronavirus disease 2019 (COVID-19). Describing characteristics, consultation demands, patients’ needs, and outcomes of hospitalized patients with COVID-19 who received a palliative care evaluation. Retrospective chart review of patients (aged 18+ years) with COVID-19 admitted to an academic quaternary center and seen by the geriatrics and palliative medicine team from March 1st to May 11th, 2020. Socio-demographics, operational metrics, severity of illness, goals of care-advanced care planning documentation, and outcomes were analyzed. Three hundred seventy-six (17.6%) out of 2138 COVID-19 admissions were seen by the consultation team. Compared with prepandemic situation (September 1st, 2019, to February 29th, 2020), overall new consults (205 vs. 371, P < 0.001) significantly increased, particularly in the intensive care unit (ICU; 9.5% vs. 36.9%, P < 0.001). For the COVID-19 population, median age was 78 years (interquartile range, 70-87; range, 36-102); 56% were male. LACE score, D-dimer, and C-reactive protein suggested severe disease and increased risk of mortality. Seventy-five percent of consults were for goals of care-advanced care planning, and 9.6% for symptoms. During the index admission, 7.1% had documented advanced directives, and 69.7% became do not resuscitate. Of all deaths, 55.5% were in the ICU, and 87.2% were aged ≥65 years. Underserved minority patients had a disproportionate mortality. Overall consultation mortality (38.3% vs. 70.4%, P < 0.001) and ICU mortality (55.2% vs. 78.1%, P < 0.001) significantly increased compared with those before COVID-19. During this pandemic, understanding inpatient specialized palliative care needs and the vulnerable populations driving these causes may encourage health-care agencies and local, state, and federal governments to support the dedicated palliative care workforce.
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