背景:访问泰国急诊科(ED)的姑息患者的特征和结果,一个没有标准姑息治疗系统的国家,没有得到全面的研究。我们旨在报告ED姑息患者的特征,并调查与死亡率相关的因素。
方法:在Siriraj医院进行了一项前瞻性观察研究,曼谷,泰国,在2019年3月至2021年2月之间,通过采访姑息患者和/或其护理人员和病历审查。包括患有无法治愈的癌症或其他晚期慢性病的姑息患者。
结果:共纳入182例患者。他们的平均年龄是73岁,61.5%是女性,53.8%患有不治之症。其中,20.3%的人以前去过姑息诊所。大约60%有先进的指令,4.9%有生前遗嘱,27.5%的人对他们首选的死亡地点有计划。最常见的主诉是呼吸困难(43.4%),ED就诊的主要原因是“无法控制症状”(80%)。在ED,17%的患者曾被姑息治疗小组看过,23.1%死亡。虽然51%被录取,48.9%不能存活出院。癌症,接受了吗啡,姑息表现量表>30和ED姑息咨询与住院死亡率独立相关.
结论:对姑息治疗的认可和利用在很大程度上是不够的,特别是对于非癌症患者。从ED到家庭护理的姑息治疗系统的改进和推广是强制性的,以提高姑息患者的生活质量。
BACKGROUND: The characteristics and outcomes of palliative patients who visited the Emergency Department (ED) in Thailand, a country in which no standard palliative care system existed, have not been comprehensively studied. We aimed to report the characteristics of ED palliative patients and investigate factors associated with mortality.
METHODS: A prospective observational study was conducted at Siriraj Hospital, Bangkok, Thailand, between March 2019 and February 2021 by means of interviewing palliative patients and/or their caregivers and medical record review. Palliative patients with either incurable cancer or other end-stage chronic diseases were included.
RESULTS: A total of 182 patients were enrolled. Their mean age was 73 years, 61.5% were female, and 53.8% had incurable cancer. Of these, 20.3% had previously visited the palliative clinic. Approximately 60% had advanced directives, 4.9% had a living will, and 27.5% had plans on their preferred place of death. The most common chief complaint was dyspnea (43.4%), and the main reason for ED visits was \'cannot control symptoms\' (80%). At the ED, 17% of the patients had been seen by the palliative care team, and 23.1% died. Although 51% were admitted, 48.9% could not survive to discharge. Cancer, having received morphine, a palliative performance scale > 30, and ED palliative consultation were independently associated with hospital mortality.
CONCLUSIONS: The recognition and utilization of palliative care were largely inadequate, especially for non-cancer patients. An improvement and promotion in the palliative care system from the ED through home care are mandatory to improve the quality of life of palliative patients.