ANALYSIS OF INDICATIONS FOR INTENSIVE-CARE UNIT ADMISSION - CLINICAL EFFICACY ASSESSMENT PROJECT - AMERICAN-COLLEGE OF PHYSICIANS
ANALYSIS OF INDICATIONS FOR INTENSIVE-CARE UNIT ADMISSION - CLINICAL EFFICACY ASSESSMENT PROJECT - AMERICAN-COLLEGE OF PHYSICIANS
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DOI：
10.1378/chest.104.6.1806
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发表时间：
1993-12-01
期刊：
影响因子：
9.6
通讯作者：
GLUCK, EH
中科院分区：
文献类型：
--
作者：
BONE, RC;MCELWEE, NE;GLUCK, EH
目的：为重症监护病房（ICU）住院政策的制定提出建议。设计：对1966年至1991年期间发表的有关重症监护室或冠状动脉监护病房（CCUs）入院标准的文献进行综述。患者：研究确定了最不可能从ICU或CCU住院中获益的患者。感兴趣的患者人群包括可能需要重症监护的成年人（大于或等于18岁）；排除创伤患者。测量方法和主要结果：在970篇与重症监护相关的文章中，只有两项病例对照研究使用了直接测量ICU干预对死亡率影响的方法。没有研究发现在CCU治疗的低风险患者与在其他医院治疗的患者的结果进行比较，也没有研究发现患者预后不良的可能性很高。结论：ICU和CCU入院决策模型的使用必须在前瞻性随机临床试验中进行检验。重症监护病房和icu应该分开研究。现有的ccu早期出院研究需要总结和评价。需要评估ICU患者到其他医院地点的分诊，以及现有的早期分诊决策预测模型。
Objective: To formulate recommendations for the development of intensive care unit (ICU) admission policies.Design: Literature review of published reports over the period 1966 to 1991 pertaining to admission criteria for intensive care or coronary care units (CCUs).Patients: Studies identifying patients least likely to benefit from ICU or CCU admission were analyzed. Patient populations of interest included adults (greater-than-or-equal-to 18 years of age) with medical conditions possibly requiring intensive care; trauma patients were excluded.Measurements and main results: Of 970 articles identified as being pertinent to intensive care, only two case-control studies used the direct method of measuring the effect of ICU intervention on mortality. No studies were found that compared outcomes of low-risk patients treated in a CCU vs those treated in alternative hospital locations, and none identified patients with a very high probability of a bad outcome.Conclusions: The use of decision-making models for ICU and CCU admissions must be tested in prospective, randomized clinical trials. Critical care units and ICUs should be studied separately. Existing studies of early discharge from CCUs need to be summarized and evaluated. The triaging of ICU patients to alternative hospital locations needs to be evaluated, as do existing predictive models for early triage decision-making.