Australian Critical Care最新文献

{"title":"Comparison of Glasgow Coma Scale and Full Outline of UnResponsiveness score to assess the level of consciousness in patients admitted to intensive care units and emergency departments: A quantitative systematic review","authors":"Frida Krag Brun CCRN, MSc ,&nbsp;Vilde Holte Fagertun CCRN, MSc ,&nbsp;Marie Hamilton Larsen RN, PhD ,&nbsp;Marianne Trygg Solberg CCRN, PhD","doi":"10.1016/j.aucc.2024.03.012","DOIUrl":"10.1016/j.aucc.2024.03.012","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to investigate the reliability and validity of the Glasgow Coma Scale (GCS) and the Full Outline of UnResponsiveness (FOUR) score used by nurses and physicians to assess the level of consciousness in patients admitted to intensive care units (ICUs) and emergency departments (EDs).</div></div><div><h3>Review method used</h3><div>This systematic review was guided by the Cochrane Handbook for Systematic Reviews of Interventions and followed the reporting standards of the Preferred Reporting Items for Systematic Review and Meta-Analysis Statement.</div></div><div><h3>Data sources</h3><div>A systematic search was conducted using the following databases: CINAHL, MEDLINE, and EMBASE.</div></div><div><h3>Review methods</h3><div>All authors performed the study selection process, data collection, and assessment of quality. The following psychometric properties were addressed: inter-rater reliability, internal consistency, and construct validity.</div></div><div><h3>Results</h3><div>Six articles were included. The GCS and the FOUR scores demonstrated excellent reliability and very strong validity when used by nurses and physicians to assess the level of consciousness in patients admitted to the ICU and ED. The FOUR score demonstrated slightly higher overall reliability and validity than the GCS.</div></div><div><h3>Conclusion</h3><div>This systematic review indicates that the FOUR score is especially suitable for assessing the level of consciousness in patients admitted to the ICU and ED. The FOUR score demonstrated higher reliability and validity than the GCS, making it a promising alternative assessment scale, despite the GCS’s longstanding use in clinical practice.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101057"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141082568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and risk factors associated within 48-hour unplanned paediatric intensive care unit readmissions: An integrative review","authors":"Martina K. Barnwell RN BNurs, MAP ,&nbsp;Huaqiong Zhou RN, BSc, PhD ,&nbsp;Simon Erickson FRACP FCICM, DipEcho","doi":"10.1016/j.aucc.2024.03.010","DOIUrl":"10.1016/j.aucc.2024.03.010","url":null,"abstract":"<div><h3>Background</h3><div>Unplanned paediatric intensive care unit (PICU) readmission is associated with increased morbidity/mortality, hospital length of stay, and health service cost and is recognised as a key performance indicator of quality-of-care delivery. However, research evidence on unplanned PICU readmission risk factors is limited, and results were inconsistent across studies.</div></div><div><h3>Aim</h3><div>The aim of this experiment was to collate and synthesise unplanned within-48-h PICU readmission prevalence and associated risk factors.</div></div><div><h3>Methods</h3><div>An integrative review was conducted, guided by a five-stage framework. Seven electronic databases were searched (2013–30th June 2023). Studies published in English with full-text accessibility and detailed methodologies were included. The quality of included studies was critically appraised using the Joanna Briggs Institute checklists. Prevalence and risk factors were extracted, synthesised, and presented narratively.</div></div><div><h3>Results</h3><div>Ten studies met eligibility criteria and reported a varied readmission rate from 0.008% to 6.49%. Fifteen types of significant risk factors were extracted. Twelve consistently cited risk factors were age, weight, complex chronic conditions, admission source, unplanned admission, PICU length of stay, positive pressure ventilation, discharge disposition, oxygen requirements, respiratory rate, heart rate, and Glasgow Coma Score at discharge. Of the 12, five predictors were classified as modifiable factors, including discharge disposition, oxygen requirement, abnormal respiratory rate, abnormal heart rate, and decreased Glasgow Coma Score at discharge.</div></div><div><h3>Conclusion</h3><div>This review acknowledges the complexity of confounding factors impacting unplanned PICU readmission and the lack of standardisation examining potential risk factors. The five modifiable factors are suggestive of clinical instability and premature PICU discharge. Patients with modifiable risk factors should have their readiness for discharge re-evaluated. Scaffolding support to manage patients at risk of readmission includes senior bedside nursing allocation, use of PICU outreach services, and 1:2 nurse-to-patient ratios in the ward setting, which are warranted to ensure patient safety.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101055"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140900364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing characteristics and outcomes of in-hospital cardiac arrest during the early and late COVID-19 pandemic at an academic institution in Saudi Arabia","authors":"Abdullah Bakhsh MBBS ,&nbsp;Saleh Binmahfooz MBBS ,&nbsp;Ibtihal Balubaid MBBS ,&nbsp;Hind Aljedani MBBS ,&nbsp;Mohsin Khared MBBS ,&nbsp;Abdulrahman Alghamdi MBBS ,&nbsp;Saleh Alabdulwahab MBBS ,&nbsp;Mohannad Alzahrani MBBS ,&nbsp;Aziza Abushosha MBBS ,&nbsp;Layan Alharbi MBBS ,&nbsp;Reem Baarma MBBS ,&nbsp;Elmoiz Babekir MBBS","doi":"10.1016/j.aucc.2024.06.005","DOIUrl":"10.1016/j.aucc.2024.06.005","url":null,"abstract":"<div><h3>Background</h3><div>The COVID-19 pandemic has introduced major changes in the resuscitation practices of cardiac arrest victims.</div></div><div><h3>Aim</h3><div>We aimed to compare the characteristics and outcomes of patients who sustained in-hospital cardiac arrest (IHCA) during the early COVID-19 pandemic period (2020) with those during the late COVID-19 pandemic period (2021).</div></div><div><h3>Methods</h3><div>This was a retrospective review of adult patients sustaining IHCA at a single academic centre. We compared characteristics and outcomes of IHCA for 5 months in 2020 with those experiencing IHCA for 5 months in 2021.</div></div><div><h3>Results</h3><div>Patients sustaining IHCA during the early COVID-19 pandemic period had higher rates of delayed epinephrine administration of more than 5 min (13.4% vs. 1.9%; p &lt; 0.01), more frequent delays in the initiation of chest compressions (55.6% vs. 17.9%; p &lt; 0.01), and were intubated less often (23.0% vs. 59.3%; p &lt; 0.01). In terms of outcomes, both return of spontaneous circulation (35.8% vs. 51.2%; p &lt; 0.01) and survival to hospital discharge rates (13.9% vs. 30.2%; p &lt; 0.01) were lower during the early COVID-19 pandemic period.</div></div><div><h3>Conclusions</h3><div>The early COVID-19 pandemic period was associated with delays in epinephrine administration and chest compression initiation for IHCA. Moreover, both return of spontaneous circulation and survival to hospital discharge were lower during the early COVID-19 pandemic period.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101082"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141581461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Creating a home with a critically ill child: A qualitative study exploring the experiences of parents of children admitted to paediatric critical care following treatment in neonatal care","authors":"Sarah E. Seaton PhD ,&nbsp;Joseph C. Manning RN, PhD ,&nbsp;Gillian Colville MPhil, PhD ,&nbsp;Nicola Mackintosh PhD","doi":"10.1016/j.aucc.2024.07.082","DOIUrl":"10.1016/j.aucc.2024.07.082","url":null,"abstract":"<div><h3>Background</h3><div>Survival of children with complex medical conditions has increased over time. Around 5% of children admitted to a neonatal unit (NNU) later have an admission to a paediatric intensive care unit (PICU) in early life. No work to date has explored the needs of parents who have a child admitted to both of these healthcare settings.</div></div><div><h3>Objective</h3><div>The overall aim of this study was to understand parents' experiences as they navigate the transition between admissions to the NNU and the PICU. This paper reports on one of the themes (creating a home) identified inductively from the dataset.</div></div><div><h3>Methods</h3><div>We used a qualitative research design using semistructured interviews with parents who had a child (or children) who had been admitted to neonatal care after birth and then subsequently were also admitted to a PICU. We recruited a national purposive sample of parents with experiences of having a child treated in an NNU before being admitted to the PICU. We undertook the interviews and transcribed them before taking a reflexive thematic analysis approach.</div></div><div><h3>Results</h3><div>A total of 15 mothers and three fathers, of 17 children, were interviewed between January and March 2022. ‘We identified ‘creating a home’ as a key inductive theme with three subthemes: (i) developing parental roles; (ii) creating a physical home; and (iii) creating core memories.</div></div><div><h3>Conclusions</h3><div>There is a growing cohort of children living with chronic health conditions. In this work, we have explored how their parents establish a home whilst often spending significant periods within the public arena of intensive care. Families across settings need support from healthcare professionals to help them develop their role as parents, build a home, and to create memories together.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101101"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nurse-led dysphagia screening in the intensive care unit – An implementation study","authors":"Anne Højager Nielsen CCRN, MCN, PhD ,&nbsp;Robert Winding MD ,&nbsp;Bettina Hvas Busk ,&nbsp;Lillian Noe ,&nbsp;Birthe Husted CCRN, MHH ,&nbsp;Gitte Juhl Kristensen CCRN ,&nbsp;Helle Svenningsen CCRN, MCN, PhD ,&nbsp;Therese Ovesen MD, DMSc","doi":"10.1016/j.aucc.2024.07.081","DOIUrl":"10.1016/j.aucc.2024.07.081","url":null,"abstract":"<div><h3>Background</h3><div>Postextubation is common in the intensive care unit, and bedside screening by nurses is important to detect the condition and avoid aspiration to the airways.</div></div><div><h3>Objective</h3><div>The objective of this study was to assess the implementation of nurse-led, systematic dysphagia screening in the intensive care unit and to identify barriers and facilitators for dysphagia screening.</div></div><div><h3>Methods</h3><div>Design: pragmatic implementation study. Based on a programme theory, key behaviours were identified using the Behaviour Change Wheel framework. Implementation activities included education, e-learning, bedside peer support, feedback, and cues in the environment. Data sources included chart reviews, participant logs, implementation log and focus-group interviews.</div></div><div><h3>Results</h3><div>Participant logs showed 94% of nurses participated in educational sessions, less in e-learning (67%). Chart reviews showed very little use of nurse-led dysphagia screening. Only 19% of extubated patients followed screening protocol. Focus groups showed that nurses accepted the Yale Swallow Protocol as valid that new skills and understandings led to empowerment of nurses and aided decision making. Important barriers were keeping patients nil-per-mouth for intubation, lack of social support from other professionals, and difficulties with documentation. Facilitators were social support from colleagues.</div></div><div><h3>Conclusion</h3><div>Implementation of nurse-led screening in intensive care was possible but challenged by external factors. Attention should be given to alterations of the screening protocol to avoid alteration of the instrument and easy documentation. Implementation of nurse-led dysphagia screening in intensive care may facilitate safe oral intake in patients and identify patients in need of specialised assessment. Implementation should aim to provide nurses with competences in screening patients swallowing function and allow contextualisation without altering the properties of the instrument.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101100"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Chinese Mandarin COMHON Index and Braden Scale to assess pressure injury risk in intensive care: An inter-rater reliability and convergent validity study","authors":"Josephine Lovegrove RN, PhD ,&nbsp;Paul Fulbrook RN, PhD ,&nbsp;Cui Yuan RN, MN ,&nbsp;Frances Lin RN, PhD ,&nbsp;Xian-Liang Liu RN, MD, PhD","doi":"10.1016/j.aucc.2024.05.015","DOIUrl":"10.1016/j.aucc.2024.05.015","url":null,"abstract":"<div><h3>Background</h3><div>The COMHON Index is an intensive-care-specific pressure injury risk assessment tool, which has demonstrated promising psychometric properties. It has been translated into Chinese Mandarin but requires inter-rater reliability testing and comparison to the standard care instrument (Braden Scale) before clinical use.</div></div><div><h3>Objectives</h3><div>This study aimed to test and compare the inter-rater reliability and convergent validity of the Chinese Mandarin versions of the COMHON Index and Braden Scale.</div></div><div><h3>Methods</h3><div>The study was conducted in a Chinese comprehensive intensive care unit. Based on a sample size calculation, five registered nurse raters with at least 6-months experience independently conducted risk assessments for 20 adult patients using both the COMHON Index and Braden Scale. Intraclass correlations (ICC) for inter-rater reliability, standard errors of measurement (SEM), and minimally detectable change (MDC) were calculated. Convergent validity was assessed using Pearson Product Moment Correlation for sum scores and Spearman's rho for subscales.</div></div><div><h3>Results</h3><div>Inter-rater reliability of COMHON Index and Braden Scale sum scores was very high (ICC [1,1] = 0.973; [95% confidence interval 0.949–0.988]; SEM 0.54; MDC 1.50) and high (ICC [1,1] = 0.891; [95% confidence interval 0.793-0.951]; SEM 0.93; MDC 2.57), respectively. All COMHON-Index subscales demonstrated ICC values &gt;0.6, whereas two Braden Scale subscales (<em>Mobility</em>, <em>Activity</em>) were below this threshold. Instrument sum scores were strongly correlated (Pearson's <em>r =</em> −0.76 [<em>r</em>^<em>2</em> = 0.58]; <em>p</em> &lt; 0.001), as were three subscale item pairs (mobility <em>r</em>_<em>s</em> <em>=</em> −0.56 [<em>r</em>^<em>2</em> = 0.32]; nutrition <em>r</em>_<em>s</em> <em>=</em> −0.63 [<em>r</em>^<em>2</em> = 0.39]; level of consciousness/sensory perception <em>r</em>_<em>s</em> <em>=</em> −0.67 [<em>r</em>^<em>2</em> = 0.45] <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Both the COMHON Index and Braden Scale demonstrated high levels of inter-rater reliability and measured similar constructs. However, the COMHON Index demonstrated superior inter-rater reliability and the results suggest that it better detects changes in patient condition and subsequently pressure injury risk. Further testing is recommended.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101093"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141918023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutritional gap after transfer from the intensive care unit to a general ward – A retrospective quality assurance study","authors":"Anne Wilkens Knudsen RN, RD, PhD ,&nbsp;Simone Møller Hansen RD, BN ,&nbsp;Thordis Thomsen RN, PhD ,&nbsp;Heidi Knudsen RN, BN ,&nbsp;Tina Munk RD, PhD","doi":"10.1016/j.aucc.2024.07.083","DOIUrl":"10.1016/j.aucc.2024.07.083","url":null,"abstract":"<div><h3>Background</h3><div>Adequate nutrition is important for recovery after critical illness. Even so, our knowledge of patients' nutritional intake after intensive care unit (ICU) discharge is scarce.</div></div><div><h3>Objectives</h3><div>We aimed to explore nutritional planning and achieved nutritional intake in ICU patients who transfer from the ICU to general wards.</div></div><div><h3>Methods</h3><div>A retrospective quality assurance study. Inclusion criteria: adult ICU patients transferring to a general ward at Copenhagen University Hospital-Herlev from May to August 2021. Primary outcomes were as follows: having a nutritional plan on the day of ICU transfer. A nutritional plan was defined as follows: (i) individual assessment of energy and protein requirement; (ii) intake, documented as achieved percentage of energy and protein requirements; (iii) prescribed type of nutrition. If using enteral or parenteral nutrition; (iv) the prescribed doses; and (v) the prescribed product. Secondary outcomes were as follows: achieved percentage of energy and protein requirements from day -1 before ICU transfer until day +1 and day +3 after ICU transfer.</div></div><div><h3>Results</h3><div>We included 57 patients; the mean age was 64 years (±11.1); 43 (75%) patients were male; the median ICU stay was 6 days (interquartile range: 3–11). One (2%) patient had a full nutritional plan according to listed criteria. Patients' median percentage of requirements met declined significantly from the day before to the day after ICU discharge (energy: from 94% to 30.5%; p = 0.0051; protein: from 73% to 27.5%; p = 0.0117). The decline in percentage of requirements met remained unchanged from day 1 to 3 after ICU transfer.</div></div><div><h3>Conclusions</h3><div>In conclusion, few patients had a nutritional plan when transferring from the ICU to a general ward. After ICU discharge, percentage of energy and protein requirements met declined significantly and remained insufficient during the first 3 days at the general ward.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101102"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142047487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EMpowerment of PArents in THe Intensive Care: A multicentre validation study in Japan","authors":"Yujiro Matsuishi RN, PhD ,&nbsp;Joseph C. Manning RN, PhD ,&nbsp;Haruhiko Hoshino RN, PhD ,&nbsp;Yuki Enomoto MD, PhD ,&nbsp;Ikkei Munekawa RN, MS ,&nbsp;Ryo Ikebe RN, MS ,&nbsp;Masanori Tani MD ,&nbsp;Naoko Tanaka RN, MS ,&nbsp;Bryan J. Mathis PhD ,&nbsp;Nobutake Shimojo MD, PhD ,&nbsp;Yoshiaki Inoue MD, PhD ,&nbsp;Jos M. Latour RN, PhD","doi":"10.1016/j.aucc.2024.05.009","DOIUrl":"10.1016/j.aucc.2024.05.009","url":null,"abstract":"<div><h3>Background</h3><div><span>The importance of assessing family satisfaction in paediatric<span> intensive care units (PICUs) is becoming increasingly recognised. The survey, EMpowerment of Parents in THe </span></span>Intensive Care “EMPATHIC-30”, was designed to assess family satisfaction and has been translated and implemented in several countries but not yet in Japan.</div></div><div><h3>Objectives</h3><div>The objective of this study was to translate, culturally adapt, and validate the EMPATHIC-30 questionnaire in Japanese and to identify potential factors for family-centred care satisfaction.</div></div><div><h3>Methods</h3><div><span>We translated and adapted for patient-reported outcome measures via a 10-step process outlined by the Principles of Good Practice. Four paediatric PICUs in Japan participated in the validation study, and the parental enrolment criterion was a child with a PICU stay of &gt;24 h. Reliability was measured by Cronbach's α, and congruent validity was tested with overall satisfaction-with-care scales by correlation analysis. Multivariate </span>linear regression modelling was conducted to identify factors related to each domain of the Japanese EMPATHIC-30.</div></div><div><h3>Results</h3><div>A total of 163 parents (mean age: 31.9 ± 5.4 years; 81% were mothers) participated. The five domains of the Japanese EMPATHIC-30 showed high reliability (α = 0.87 to 0.97) and congruent validity, demonstrating high correlations with overall satisfaction in nurses (r = 0.75) and doctors (r = 0.76). Multivariate modelling found that elective admission, mechanical ventilation<span>, and parents who had experience of a family member in an adult intensive care unit had higher satisfaction scores in all five domains (p &lt; 0.05). Moreover, Buddhists assigned higher satisfaction scores in the Care and Treatment domain (p = 0.03).</span></div></div><div><h3>Conclusions</h3><div>The Japanese EMPATHIC-30 questionnaire has demonstrated adequate reliability and validity measures. We also identified that elective admission, mechanical ventilation, and having previous adult intensive care unit experience of a family member were factors in assigning higher scores for all satisfaction domains. PICU clinicians need to be cognisant of ethical, cultural, and religious factors relating to the critically ill child and their family.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101072"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141565109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty as a trigger for goals-of-care discussions in rapid response calls: A single-centre retrospective cohort study","authors":"Deb Sharp MN ,&nbsp;Dean McKenzie PhD ,&nbsp;Laven Padayachee MBBS, FACEM, FCICM ,&nbsp;Ashwin Subramaniam PhD","doi":"10.1016/j.aucc.2024.06.011","DOIUrl":"10.1016/j.aucc.2024.06.011","url":null,"abstract":"<div><h3>Background</h3><div>Timely goals-of-care (GOC) discussions are essential for end-of-life planning, particularly during acute hospital admissions, where ambiguity often persists. Frailty, prevalent in the ageing population and linked to adverse outcomes, underscores the need to align treatment strategies with quality of life. Recognising frailty as a trigger for GOC discussions during rapid response calls (RRCs) is critical for efficient resource management and improving patient outcomes.</div></div><div><h3>Methods</h3><div>This single-centre retrospective cohort study included all hospitalised patients aged ≥65 years admitted between September 2021 and June 2023 who experienced an RRC. Frailty was assessed using the Clinical Frailty Scale (CFS) during the RRC. The primary outcome was to investigate whether frailty, specifically assessed by the CFS as screened during an RRC, could be a suitable clinical trigger for initiating GOC discussions. We also aimed to identify the proportion of patients with frailty (CFS score: ≥5) and predictors at the time of RRC, resulting in recommendations for GOC discussions.</div></div><div><h3>Results</h3><div>Among 4954 patients, 1685 (34.0%) were classified as frail (CFS score: ≥5). Recommendations increased with frailty levels (nonfrail [CFS score: 1–4]: 6.6%, mildly frail [CFS score: 5]: 19.3%, moderate-to-severely frail [CFS score: 6–9]: 32.2%; p &lt; 0.001). Frailty independently increased the probability of GOC recommendations during an RRC (area under the receiver operating characteristic curve = 0.71). The CFS cut-off point for GOC recommendations was ≥5. The presence of frailty was associated with higher odds of receiving GOC recommendations for mildly frail (CFS score: 5; odds ratio [OR] = 2.53; 95% confidence interval: 1.96–3.27) and moderate-to-severely frail (CFS score: 6–9; OR = 4.69; 95% confidence interval: 3.81–5.78) compared to nonfrail patients.</div></div><div><h3>Conclusion</h3><div>Frailty, identified during an RRC, served as a robust trigger for GOC recommendations, highlighting the importance of tailored proactive discussions before episodes of deterioration. Higher levels of frailty (CFS score: ≥5) demonstrate practical markers for aiding clinicians with proactive GOC discussions.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101090"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Article-based publishing: bring research to clinicians","authors":"Samantha Keogh RN, PhD,&nbsp;Andrea P. Marshall RN, PhD","doi":"10.1016/j.aucc.2024.101160","DOIUrl":"10.1016/j.aucc.2024.101160","url":null,"abstract":"","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101160"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}