The Eldicus prospective, observational study of triage decision making in European intensive care units. Part II: Intensive care benefit for the elderly
The Eldicus prospective, observational study of triage decision making in European intensive care units. Part II: Intensive care benefit for the elderly
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DOI：
10.1097/ccm.0b013e318232d6b0
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发表时间：
2012-01-01
影响因子：
8.8
通讯作者：
Iapichino, Gaetano
中科院分区：
文献类型：
--
作者：
Sprung, Charles L.;Artigas, Antonio;Iapichino, Gaetano
理由：生死分诊决定是由重症监护室医生每天做出的。当重症监护病房资源有限时，特别是对老年人，拒绝接受重症监护病房。目的：确定重症监护病房分诊决定对死亡率和重症监护病房效益的影响，特别是对老年患者。设计：从2003年9月至2005年3月对分诊决定进行前瞻性观察性研究。环境：7个欧洲国家的11个重症监护室。患者：所有年龄在18岁以下且明确要求入住重症监护病房的患者。干预措施：入院或拒绝重症监护病房。测量方法和主要结果：获得了连续患者的人口学、临床、医院、生理变量和28天死亡率。6796例患者中有8472例分诊，5602例（82%）被纳入重症监护病房，1194例（18%）被拒绝；3795人（49%）在65岁以下。拒绝率随着患者年龄的增加而增加（18-44岁：11%；45-64岁：15%；65-74岁：18%；75-84岁：23%；84岁以下：36%）。老年患者死亡率较高（18-44岁：11%；45-64岁：21%；65-74岁：29%；75-84岁：37%；84岁：48%）。然而，接受与拒绝患者的死亡率差异在老年患者中最大（18-44岁：10.2% vs. 12.5%； 45-64岁：21.2% vs. 22.3%； 65-74岁：27.9% vs. 34.6%； 75-84岁：35.5% vs. 40.4%； 84岁：41.5% vs. 58.5%）。Logistic回归显示，接受治疗的老年患者（年龄0 ~ 65岁）与拒绝治疗的老年患者（年龄0.55 ~ 65岁）相比，接受治疗的患者死亡率降低幅度更大
Rationale: Life and death triage decisions are made daily by intensive care unit physicians. Admission to an intensive care unit is denied when intensive care unit resources are constrained, especially for the elderly.Objective: To determine the effect of intensive care unit triage decisions on mortality and intensive care unit benefit, specifically for elderly patients.Design: Prospective, observational study of triage decisions from September 2003 until March 2005.Setting: Eleven intensive care units in seven European countries.Patients: All patients >18 yrs with an explicit request for intensive care unit admission.Interventions: Admission or rejection to intensive care unit.Measurements and Main Results: Demographic, clinical, hospital, physiologic variables, and 28-day mortality were obtained on consecutive patients. There were 8,472 triages in 6,796 patients, 5,602 (82%) were accepted to the intensive care unit, 1,194 (18%) rejected; 3,795 (49%) were >65 yrs. Refusal rate increased with increasing patient age (18-44: 11%; 45-64: 15%; 65-74: 18%; 75-84: 23%; >84: 36%). Mortality was higher for older patients (18-44: 11%; 45-64: 21%; 65-74: 29%; 75-84: 37%; >84: 48%). Differences between mortalities of accepted vs. rejected patients, however, were greatest for older patients (18-44: 10.2% vs. 12.5%; 45-64: 21.2% vs. 22.3%; 65-74: 27.9% vs. 34.6%; 75-84: 35.5% vs. 40.4%; >84: 41.5% vs. 58.5%). Logistic regression showed a greater mortality reduction for accepted vs. rejected patients corrected for disease severity for elderly patients (age >65 [odds ratio 0.65, 95% confidence interval 0.550.78, p