虚弱是快速反应呼叫中进行护理目标讨论的触发因素：单中心回顾性队列研究。

IF 2.6 3区医学 Q2 CRITICAL CARE MEDICINE

Australian Critical Care Pub Date : 2025-01-01 DOI:10.1016/j.aucc.2024.06.011

Deb Sharp MN , Dean McKenzie PhD , Laven Padayachee MBBS, FACEM, FCICM , Ashwin Subramaniam PhD

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引用次数: 0

摘要

背景：及时讨论护理目标（GOC）对于生命末期规划至关重要，尤其是在急性入院期间，因为在这种情况下，模糊性往往持续存在。老龄化人口中普遍存在的体弱现象与不良预后有关，这凸显了根据生活质量调整治疗策略的必要性。在快速反应呼叫（RRC）过程中，认识到体弱是引发GOC讨论的一个因素，这对有效管理资源和改善患者预后至关重要：这项单中心回顾性队列研究纳入了 2021 年 9 月至 2023 年 6 月期间入院并经历过 RRC 的所有年龄≥65 岁的住院患者。在 RRC 期间，使用临床虚弱量表（CFS）对虚弱程度进行评估。主要结果是调查在 RRC 期间通过 CFS 筛选出的体弱情况是否可以作为启动 GOC 讨论的合适临床触发因素。我们还旨在确定体弱（CFS评分：≥5分）患者的比例以及在进行RRC时的预测因素，从而为GOC讨论提供建议：结果：在 4954 名患者中，有 1685 人（34.0%）被归类为体弱（CFS 评分：≥5 分）。建议随虚弱程度的增加而增加（非虚弱[CFS 评分：1-4]：6.6%；轻度虚弱[CFS 评分：5]：19.3%；中度至严重虚弱[CFS 评分：5]：1.5%；中度至严重虚弱[CFS 评分：5]：1.5%）：19.3%，中度至重度虚弱 [CFS 评分：6-9]：32.2%; p 结论：在 RRC 中发现的体弱情况是 GOC 建议的一个强有力的触发因素，突出了在病情恶化之前进行有针对性的积极讨论的重要性。较高的虚弱程度（CFS评分：≥5分）是帮助临床医生积极开展GOC讨论的实用指标。

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Frailty as a trigger for goals-of-care discussions in rapid response calls: A single-centre retrospective cohort study

Background

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.

Methods

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.

Results

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 < 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.

Conclusion

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.

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来源期刊

Australian Critical Care NURSING-NURSING

CiteScore

4.90

自引率

9.10%

发文量

148

审稿时长

>12 weeks

期刊介绍： Australian Critical Care is the official journal of the Australian College of Critical Care Nurses (ACCCN). It is a bi-monthly peer-reviewed journal, providing clinically relevant research, reviews and articles of interest to the critical care community. Australian Critical Care publishes peer-reviewed scholarly papers that report research findings, research-based reviews, discussion papers and commentaries which are of interest to an international readership of critical care practitioners, educators, administrators and researchers. Interprofessional articles are welcomed.