在手术重症监护病房的生命末期痛苦中的种族差异
Diane N Haddad1, Nicole Meredyth2, Justin Hatchimonji1
1Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Trauma surgery & acute care open
|September 19, 2024
概括
提供者对外科重症监护室 (SICU) 预期死亡的评估与"不复苏" (DNR) 状态有关,特别是对于非创伤患者. 黑人患者不太可能有DNR状态,突出了终身护理的差异.
科学领域:
- 关键护理医学 关键护理医学
- 抚慰性护理是一种缓解性护理.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 生命终端 (EOL) 护理是资源密集的.
- 识别和沟通EOL可以改善以患者为中心的护理,并减少徒劳的干预.
- 医疗服务提供者对SICU无用性的评估可能会影响"不复苏" (DNR) 状态.
研究的目的:
- 调查SICU患者预期生存期和DNR状态的提供者评估之间的关联.
- 为了检查已故的SICU患者中DNR状态的基于种族的差异.
主要方法:
- 对未来的SICU注册表 (2018-2022) 的回顾性审查.
- 包括主观的提供者对预期生存时间的评估.
- 多变量后勤回归以调整临床因素并评估与代码状态和种族的关联.
主要成果:
- 26.3%的死亡是由ICU提供者预料到的.
- 预期死亡与非创伤患者的DNR更高的几率相关 (OR 1.8),但不是创伤患者 (OR 0.82).
- 在调整后,黑人患者不太可能有DNR状态 (OR0.49).
结论:
- 20%的已故SICU患者缺乏DNR状态.
- 受伤的黑人患者在死亡时更有可能是全代码.
- 需要进一步评估,以优化EOL识别和沟通,以防止痛苦.
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