Analysis of Diagnoses, Symptoms, Medications, and Admissions Among Patients With Cancer Presenting to Emergency Departments
Analysis of Diagnoses, Symptoms, Medications, and Admissions Among Patients With Cancer Presenting to Emergency Departments
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DOI：
10.1001/jamanetworkopen.2019.0979
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发表时间：
2019-03-01
影响因子：
13.8
通讯作者：
Lyman, Gary H.
中科院分区：
文献类型：
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作者：
Caterino, Jeffrey M.;Adler, David;Lyman, Gary H.
重要性更好地了解癌症患者的紧急护理需求将通知门诊和急诊科（艾德）management.OBJECTIVE提供一个基准描述的患者谁目前的艾德与活动cancer.DESIGN，设置，和参与者这个多中心的前瞻性队列研究包括18个隶属于综合肿瘤急诊研究网络（关注）的ED。在1564名合格患者中，从2016年2月1日至2017年1月30日纳入了1075名患有活动性癌症的成人。分析了2018年2月1日至8月1日的数据。主要结局和指标：在艾德访视前和访视期间报告症状（例如疼痛、恶心）的患者比例、艾德和门诊用药、最常见诊断和艾德抗生素给药指示的疑似感染。比例观察，承认，并与住院时间（LOS）不超过2 days.Results的1075名参与者，平均（SD）年龄为62（14）岁，51.8%是女性。794名参与者（73.9%; 95% CI，71.1%-76.5%）在前30天内接受了癌症治疗; 674名（62.7%; 95% CI，59.7%-65.6%）患有晚期或转移性癌症; 505名（47.0%; 95% CI，43.9%-50.0%）年龄≥ 65岁。5种最常见的艾德诊断与症状相关。在所有参与者中，（7.6%; 95% CI，6.1%-9.4%）被置于观察组，615（57.2%; 95% CI，54.2%-60.2%）; 615例住院患者中有154例（25.0%; 95% CI，21.7%-28.7%）的LOS为2天或更短（中位数，3天;四分位距，2-6天）。艾德访视期间，668例患者（62.1%; 95% CI，59.2%-65.0%;平均[SD]疼痛评分，6.4 [2.6]/10.0）和776例患者（72.2%）在前一周出现疼痛。386例中度至重度艾德疼痛患者中有228例（59.1%; 95% CI，18.8%-23.8%）在艾德接受阿片类药物治疗。在ED前疼痛患者中，368例患者（47.4%; 95% CI，3.14%-37.2%）接受了门诊阿片类药物治疗，其中428例患者中有244例（57.0%; 95% CI，52.2%-61.8%）报告了相当多或非常多的疼痛。336例（31.3%; 95% CI，28.5%-34.1%）艾德出现恶心;其中160例（47.6%; 95% CI，12.8%-17.1%）在ED接受止吐药治疗。285例（26.5%; 95% CI，23.9%-29.2%）患者在艾德接受抗生素治疗。其中，209名患者（73.3%; 95% CI，17.1%-21.9%），而790例患者中有427例（54.1%; 95%CI，50.5%-57.6%）未接受抗生素治疗。一项描述在艾德接受治疗的癌症患者的多中心研究确定了该患者人群的共同特征，并提出了优化艾德访视之前、期间和之后的护理。改善需要专家和急诊医生之间的合作，优化艾德的使用，改善症状控制，避免不必要的住院治疗，并适当地分层风险，以确保安全的艾德治疗和癌症患者的处置。
IMPORTANCE Better understanding of the emergency care needs of patients with cancer will inform outpatient and emergency department (ED) management.OBJECTIVE To provide a benchmark description of patients who present to the ED with active cancer.DESIGN, SETTING, AND PARTICIPANTS This multicenter prospective cohort study included 18 EDs affiliated with the Comprehensive Oncologic Emergencies Research Network (CONCERN). Of 1564 eligible patients, 1075 adults with active cancer were included from February 1, 2016, through January 30, 2017. Data were analyzed from February 1 through August 1, 2018.MAIN OUTCOMES AND MEASURES The proportion of patients reporting symptoms (eg, pain, nausea) before and during the ED visit, ED and outpatient medications, most common diagnoses, and suspected infection as indicated by ED antibiotic administration. The proportions observed, admitted, and with a hospital length of stay (LOS) of no more than 2 days were identified.RESULTS Of 1075 participants, mean (SD) age was 62 (14) years, and 51.8% were female. Seven hundred ninety-four participants (73.9%; 95% CI, 71.1%-76.5%) had undergone cancer treatment in the preceding 30 days; 674 (62.7%; 95% CI, 59.7%-65.6%) had advanced or metastatic cancer; and 505 (47.0%; 95% CI, 43.9%-50.0%) were 65 years or older. The 5 most common ED diagnoses were symptom related. Of all participants, 82 (7.6%; 95% CI, 6.1%-9.4%) were placed in observation and 615 (57.2%; 95% CI, 54.2%-60.2%) were admitted; 154 of 615 admissions (25.0%; 95% CI, 21.7%-28.7%) had an LOS of 2 days or less (median, 3 days; interquartile range, 2-6 days). Pain during the ED visit was present in 668 patients (62.1%; 95% CI, 59.2%-65.0%; mean [SD] pain score, 6.4 [2.6] of 10.0) and in 776 (72.2%) during the prior week. Opioids were administered in the ED to 228 of 386 patients (59.1%; 95% CI, 18.8%-23.8%) with moderate to severe ED pain. Outpatient opioids were prescribed to 368 patients (47.4%; 95% CI, 3.14%-37.2%) of those with pre-ED pain, including 244 of 428 (57.0%; 95% CI, 52.2%-61.8%) who reported quite a bit or very much pain. Nausea in the ED was present in 336 (31.3%; 95% CI, 28.5%-34.1%); of these, 160 (47.6%; 95% CI, 12.8%-17.1%) received antiemetics in the ED. Antibiotics were administered in the ED to 285 patients (26.5%; 95% CI, 23.9%-29.2%). Of these, 209 patients (73.3%; 95% CI, 17.1%-21.9%) were admitted compared with 427 of 790 (54.1%; 95% CI, 50.5%-57.6%) not receiving antibiotics.CONCLUSIONS AND RELEVANCE This initial prospective, multicenter study profiling patients with cancer who were treated in the ED identifies common characteristics in this patient population and suggests opportunities to optimize care before, during, and after the ED visit. Improvement requires collaboration between specialists and emergency physicians optimizing ED use, improving symptom control, avoiding unnecessary hospitalizations, and appropriately stratifying risk to ensure safe ED treatment and disposition of patients with cancer.