Quality of life before intensive care using EQ-5D: patient versus proxy responses.
Quality of life before intensive care using EQ-5D: patient versus proxy responses.
复制标题
DOI：
10.1097/ccm.0b013e318265f340
复制
发表时间：
2013-01
影响因子：
8.8
通讯作者：
Needham DM
中科院分区：
文献类型：
--
作者：
Dinglas VD;Gifford JM;Husain N;Colantuoni E;Needham DM
比较重症监护住院前患者回顾性报告的基线生活质量与人群标准和代理报告。前瞻性队列研究。美国马里兰州巴尔的摩4家教学医院的13个重症监护室。140名急性肺损伤幸存者及其指定代理人。在出院时，要求患者和代理人使用EQ-5D生活质量量表回顾性估计患者入院前的基线生活质量。平均患者评定EQ-5D视觉模拟量表评分和效用评分显著低于人群标准，但显著高于代理评分。然而，患者与人群标准或代理之间平均效用评分的差异幅度在临床上并不重要。对于5个单独的EQ-5D域，kappa统计显示患者与代理之间的一致性为轻微至一般。Bland-Altman图表明，对于视觉模拟量表和效用评分，当患者报告高评分时，代理低估了评分，而当患者评分低时，代理高估了评分。患者回顾性报告急性肺损伤前的基线健康状况比人群标准差，而比代理报告好;然而，这些健康状况差异的程度可能不具有临床意义。在所有5个EQ-5D领域中，代理人与患者仅具有轻微至一般的一致性，使患者的更极端评分向中等评分衰减。在解释急性肺损伤幸存者基线健康状况的代理回顾性报告时需要谨慎。
To compare patient’s retrospectively reported baseline quality of life before intensive care hospitalization with population norms and proxy reports. Prospective cohort study. 13 intensive care units at 4 teaching hospitals in Baltimore, MD, USA. 140 acute lung injury survivors and their designated proxies. Around the time of hospital discharge, both patients and proxies were asked to retrospectively estimate patients' baseline quality of life before hospital admission using the EQ-5D quality of life instrument. Mean patient-rated EQ-5D visual analog scale scores and utility scores were significantly lower than population norms, but were significantly higher than proxy ratings. However, the magnitude of difference in average utility scores between patients and either population norms or proxies were not clinically important. For the 5 individual EQ-5D domains, kappa statistics revealed slight to fair agreement between patients and proxies. Bland-Altman plots demonstrated that for both the visual analog scale and utility scores, proxies underestimated scores when patients reported high ratings and overestimated scores for low patient ratings. Patients retrospectively reported worse baseline health status before acute lung injury than population norms and better status than proxy reports; however, the magnitude of these differences in health status may not be clinically important. Proxies had only slight to fair agreement with patients in all 5 EQ-5D domains, attenuating patients’ more extreme ratings towards moderate scores. Caution is required when interpreting proxy retrospective reports of baseline health status for survivors of acute lung injury.