Derivation and performance of an end-of-life practice score aimed at interpreting worldwide treatment-limiting decisions in the critically ill.
Derivation and performance of an end-of-life practice score aimed at interpreting worldwide treatment-limiting decisions in the critically ill.
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DOI：
10.1186/s13054-022-03971-9
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发表时间：
2022-04-13
期刊：
影响因子：
15.1
通讯作者：
Sprung, Charles L.
中科院分区：
文献类型：
--
作者：
Mentzelopoulos, Spyros D.;Chen, Su;Nates, Joseph L.;Kruser, Jacqueline M.;Hartog, Christiane;Michalsen, Andrej;Efstathiou, Nikolaos;Joynt, Gavin M.;Lobo, Suzana;Avidan, Alexander;Sprung, Charles L.
关键词：
重症监护室（ICU）中维持生命干预的局限性随着时间的推移而发生重大变化，并且在世界各地区存在巨大的当代差异。我们试图确定加权的临终实践评分是否可以解释限制决定中的大的，当代的，世界范围内的变化。 2015-2016年（Ethicus-2）与1999-2000年（Ethicus-1）比较研究是一项两阶段、前瞻性观察性研究，评估了来自22个欧洲ICU的4952例患者的限制决定频率。全球Ethicus-2研究是一项单阶段前瞻性观察性研究，评估了来自全球8个地区199个ICU的12，200例患者的限制决定频率。二进制寿命终止实践变量数据（1 =存在; 0 =不存在）（比较研究，22/22 ICU，n = 4592;全球研究，186/199 ICU，n = 11，574），用于家庭会议、适当护理水平的日常商议、每周会议期间的临终讨论、限制的书面触发，ICU临终指南和协议、姑息治疗和伦理咨询、ICU工作人员参加沟通或生物伦理课程以及国家临终指南和立法。关于比较研究，使用广义估计方程（GEE）分析来确定12个临终实践变量与治疗限制之间的关联。然后使用GEE衍生的寿命终了实践变量系数计算加权寿命终了实践评分。随后，使用全球研究数据集在GEE分析中验证了加权的生命周期结束实践评分。在比较研究GEE分析中，每周会议期间的临终讨论[比值比（OR）0.55，95%置信区间（CI）0.30-0.99]，临终指南[OR 0.52，（0.31-0.87）]和方案[OR 15.08，（3.88-58.59）]，姑息治疗咨询[OR 2.63，（1.23-5.60）]和临终立法[OR 3.24，1.60-6.55）]与限制决定显著相关（均P < 0.05）。在全球GEE分析中，加权临终实践评分与限制决定显著相关[OR 1.12（1.03-1.22）; P = 0.008]。比较研究得出的加权临终实践评分部分解释了全球研究在治疗局限性方面的差异。加权临终实践评分的最重要组成部分是ICU临终方案、姑息治疗咨询和国家临终立法。 在线版本包含补充材料，可通过10.1186/s13054-022-03971-9获得。
Limitations of life-sustaining interventions in intensive care units (ICUs) exhibit substantial changes over time, and large, contemporary variation across world regions. We sought to determine whether a weighted end-of-life practice score can explain a large, contemporary, worldwide variation in limitation decisions. The 2015–2016 (Ethicus-2) vs. 1999–2000 (Ethicus-1) comparison study was a two-period, prospective observational study assessing the frequency of limitation decisions in 4952 patients from 22 European ICUs. The worldwide Ethicus-2 study was a single-period prospective observational study assessing the frequency of limitation decisions in 12,200 patients from 199 ICUs situated in 8 world regions. Binary end-of-life practice variable data (1 = presence; 0 = absence) were collected post hoc (comparison study, 22/22 ICUs, n = 4592; worldwide study, 186/199 ICUs, n = 11,574) for family meetings, daily deliberation for appropriate level of care, end-of-life discussions during weekly meetings, written triggers for limitations, written ICU end-of-life guidelines and protocols, palliative care and ethics consultations, ICU-staff taking communication or bioethics courses, and national end-of-life guidelines and legislation. Regarding the comparison study, generalized estimating equations (GEE) analysis was used to determine associations between the 12 end-of-life practice variables and treatment limitations. The weighted end-of-life practice score was then calculated using GEE-derived coefficients of the end-of-life practice variables. Subsequently, the weighted end-of-life practice score was validated in GEE analysis using the worldwide study dataset. In comparison study GEE analyses, end-of-life discussions during weekly meetings [odds ratio (OR) 0.55, 95% confidence interval (CI) 0.30–0.99], end-of-life guidelines [OR 0.52, (0.31–0.87)] and protocols [OR 15.08, (3.88–58.59)], palliative care consultations [OR 2.63, (1.23–5.60)] and end-of-life legislation [OR 3.24, 1.60–6.55)] were significantly associated with limitation decisions (all P < 0.05). In worldwide GEE analyses, the weighted end-of-life practice score was significantly associated with limitation decisions [OR 1.12 (1.03–1.22); P = 0.008]. Comparison study-derived, weighted end-of-life practice score partly explained the worldwide study’s variation in treatment limitations. The most important components of the weighted end-of-life practice score were ICU end-of-life protocols, palliative care consultations, and country end-of-life legislation. The online version contains supplementary material available at 10.1186/s13054-022-03971-9.
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