Baseline quality of life before intensive care: A comparison of patient versus proxy responses
Baseline quality of life before intensive care: A comparison of patient versus proxy responses
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DOI：
10.1097/ccm.0b013e3181cd10c7
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发表时间：
2010-03-01
影响因子：
8.8
通讯作者：
Needham, Dale M.
中科院分区：
文献类型：
--
作者：
Gifford, Jeneen M.;Husain, Nadia;Needham, Dale M.
目的：比较急性肺损伤患者入院前自我报告的、回顾性基线生活质量与人群常模和回顾代理估计。设计：采用简明36生活质量调查问卷进行前瞻性队列研究。地点：马里兰巴尔的摩四所教学医院的13个重症监护病房。患者：136名急性肺损伤幸存者及其指定代理人。干预：患者和代理人均被要求在入院前使用简明36调查问卷评估患者基线生活质量。测量和主要结果：与人群常模相比，急性肺损伤患者在所有八个领域的生活质量得分都较低，但在八个领域(身体角色和一般健康)中只有两个领域的差异显著大于临床上最小的重要差异。患者和代理反应之间的平均配对差异显示没有临床上重要的差异。然而，Kappa的统计数据显示，所有领域的一致性都只是中等到中等。Bland-Altman分析显示，在所有领域中，当患者得分较低时，代理人倾向于高估生活质量，而当患者得分较高时，代理人倾向于低估生活质量。结论：对住院前生活质量的回顾评估显示，急性肺损伤患者的得分始终低于人群常模，但这种差异的大小可能并不具有临床意义。代理评估与患者评估只有中等到中等的一致性。在所有8个简短的36个生活质量领域中，代理回答代表了患者生活质量估计的衰减。(Crit Care Med 2010；38：855-860)
Objective: To compare acute lung injury patients' self-reported, retrospective baseline quality of life before their intensive care hospitalization with population norms and retrospective proxy estimates.Design: Prospective cohort study using the Short Form 36 quality-of-life survey.Setting: Thirteen intensive care units at four teaching hospitals in Baltimore, Maryland.Patients: One hundred thirty-six acute lung injury survivors and their designated proxies.Interventions: Both patients and proxies were asked to estimate patient baseline quality of life before hospital admission using the Short Form 36 survey.Measurements and Main Results: Compared with population norms, quality-of-life scores were lower in acute lung injury patients across all eight domains, but the difference was significantly greater than the minimum clinically important difference in only two of eight domains (Physical Role and General Health). The mean paired difference between patient and proxy responses revealed no clinically important difference. However, kappa statistics demonstrated only fair to moderate agreement for all domains. Bland-Altman analysis revealed that, for all domains, proxies tended to overestimate quality of life when patient scores were low and underestimate the quality of life when patient scores were high.Conclusion: Retrospective assessment of quality of life before hospitalization revealed that acute lung injury patients' scores were consistently lower than population norms, but the magnitude of this difference may not be clinically important. Proxy assessments had only fair to moderate agreement with patient assessments. Across all eight Short Form 36 quality-of-life domains, proxy responses represented an attenuation of patient quality-of-life estimates. (Crit Care Med 2010; 38: 855-860)