Palliative Care Consultations in Hospitalized Stroke Patients
Palliative Care Consultations in Hospitalized Stroke Patients
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DOI：
10.1089/jpm.2009.0278
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发表时间：
2010-04-01
影响因子：
2.8
通讯作者：
Quill, Timothy E.
中科院分区：
文献类型：
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作者：
Holloway, Robert G.;Ladwig, Susan;Quill, Timothy E.
目的：探讨卒中患者姑息咨询的模式和特点，并与非卒中咨询的特点进行比较。方法：2001年10月在斯特朗纪念医院开展姑息咨询。SMH是一家拥有765张床位的学术医疗中心，约有38,000名患者出院。对于2005至2007年的每次咨询，我们收集了与人口统计、临床和服务相关的信息。我们探讨了不同类型卒中患者的异同，包括缺血性卒中、脑出血、蛛网膜下腔出血和硬膜下血肿。此外，我们将这些数据与同期接受姑息治疗咨询的非中风患者进行比较。结果：从2005年到2007年的3年间，中风患者总共进行了101次咨询(占所有PC咨询的6.3%)。在101例会诊中，31例为缺血性中风患者，26例为脑出血患者，30例为蛛网膜下腔出血患者，14例为硬膜下血肿患者。与PC咨询服务上看到的其他常见诊断相比，接受PC咨询的中风患者功能受损更多，不太可能有能力，更有可能在医院死亡，传统症状负担更少。最常见的死亡轨迹是停用机械通气，但因中风类型而异。在这些会诊中协商的常见治疗方法包括机械通气、人工营养、气管切开术，以及不太可能的抗生素、静脉输液和各种神经外科手术。结论：中风患者是住院姑息护理咨询服务中常见的诊断。每种中风类型都代表了具有潜在不同姑息治疗需求的患者。
Objective: To determine the pattern and characteristics of palliative care (PC) consultations in patients with stroke and compare them with the characteristics of nonstroke consultations.Methods: The palliative care program at Strong Memorial Hospital (SMH) was established in October 2001. SMH is a 765-bed academic medical center with approximately 38,000 discharges. For each consult from 2005 to 2007, we collected demographic, clinical, and service-related information. We explored similarities and differences in patients with different types of stroke, including patients with ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and subdural hematoma. In addition, we compared these data to the nonstroke patients who had a palliative care consultation during the same time period.Results: Over the 3-year period from 2005 to 2007, there were a total of 101 consultations in patients with stroke (6.3% of all PC consultations). Of the 101 consultations, 31 were in patients with ischemic stroke, 26 in patients with intracerebral hemorrhage, 30 in patients with subarachnoid hemorrhage, and 14 in patients with subdural hematoma. Patients with stroke who had a PC consult were more functionally impaired, less likely to have capacity, more likely to die in the hospital, and to have fewer traditional symptom burdens than other common diagnoses seen on the PC consultation service. The most common trajectory to death was withdrawal of mechanical ventilation, but varied by type of stroke. Common treatments negotiated in these consultations included mechanical ventilation, artificial nutrition, tracheostomy, and less likely antibiobics, intravenous fluids, and various neurosurgical procedures.Conclusions: Patients with stroke are a common diagnosis seen on an inpatient palliative care consult service. Each stroke type represents patients with potentially distinct palliative care needs.