PATIENT-RELATED FACTORS ASSOCIATED WITH HOSPITAL DISCHARGE TO A CARE FACILITY AFTER CRITICAL ILLNESS
PATIENT-RELATED FACTORS ASSOCIATED WITH HOSPITAL DISCHARGE TO A CARE FACILITY AFTER CRITICAL ILLNESS
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DOI：
10.4037/ajcc2011827
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发表时间：
2011-09-01
影响因子：
2.7
通讯作者：
Hall, Jesse B.
中科院分区：
文献类型：
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作者：
Gehlbach, Brian K.;Salamanca, Victor R.;Hall, Jesse B.
许多危重病人在出院时被转移到其他护理机构，而不是回家。目的确定与危重疾病后出院到护理机构相关的患者相关因素，并估计与每个因素相关的风险程度。方法对548例危重患者进行回顾性队列研究。使用多变量logistic回归来确定出院到护理机构的独立危险因素。我们只分析了重症监护的前72小时。结果大约四分之一的危重疾病幸存者出院到护理机构而不是回家。该事件在老年患者中更常见，即使在调整了疾病严重程度和共病条件后也是如此（>= 65岁的患者与< 65岁的患者的比值比[OR] 1.8； 95%可信区间[CI]， 1.1-3.1; P = .02）。接受机械通气的患者（OR, 3.4; 95% CI, 2.0-5.8; P < .001）或以严重认知功能障碍（OR, 8.1; 95% CI, 1.3-50.6; P = .02）或力量和/或活动能力差（OR, 31.7; 95% CI, 6.4-157.3; P < .001）为特征的住院患者的风险最大。该模型具有良好的判别性（曲线下面积，0.82;95% CI, 0.77-0.86）。结论该模型不包含基线函数和社会变量，能够很好地区分危重疾病出院患者和出院患者。这些结果表明，未来的研究应侧重于呼吸衰竭的衰弱效应以及认知和神经肌肉后遗症。（美国重症监护杂志。2011;20:378-387）
Background Many critically ill patients are transferred to other care facilities instead of to home at hospital discharge.Objective To identify patient-related factors associated with hospital discharge to a care facility after critical illness and to estimate the magnitude of risk associated with each factor.Methods Retrospective cohort study of 548 survivors of critical illness in a medical intensive care unit. Multivariable logistic regression was used to identify independent risk factors for discharge to a care facility. Only the first 72 hours of intensive care were analyzed.Results Approximately one-quarter of the survivors of critical illness were discharged to a care facility instead of to home. This event occurred more commonly in older patients, even after adjustment for severity of illness and comorbid conditions (odds ratio [OR] 1.8 for patients >= 65 years of age vs patients < 65 years; 95% confidence interval [CI], 1.1-3.1; P = .02). The risk was greatest for patients who received mechanical ventilation (OR, 3.4; 95% CI, 2.0-5.8; P < .001) or had hospitalizations characterized by severe cognitive dysfunction (OR, 8.1; 95% CI, 1.3-50.6; P = .02) or poor strength and/or mobility (OR, 31.7; 95% CI, 6.4-157.3; P < .001). The model showed good discrimination (area under the curve, 0.82; 95% CI, 0.77-0.86).Conclusion The model, which did not include baseline function or social variables, provided good discrimination between patients discharged to a care facility after critical illness and patients discharged to home. These results suggest that future research should focus on the debilitating effects of respiratory failure and on conditions with cognitive and neuromuscular sequelae. (American Journal of Critical Care. 2011;20:378-387)