首选语言和种族影响 危重病儿童的代码状态
Stephanie Granada1, Michelle R Mayeda2, Jessica C Fowler2
1Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA.
Critical care explorations
|December 18, 2024
概括
非英语语言偏好 (NELP) 的儿童在PICU中获得不复苏 (DNR) 命令的几率更高,而黑人患者的几率更低. 这些人口因素显著预测了代码状态的变化.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 健康差距 研究 研究 研究 研究
- 临床结果研究研究
背景情况:
- 关于儿科重症监护室 (PICU) 中语言偏好,种族和代码状态决策之间的相互作用存在有限研究.
- 了解这些关联对于解决不同患者群体在终身护理方面的潜在差异至关重要.
研究的目的:
- 调查非英语语言偏好 (NELP) 和种族之间的关联,以及在PICU中不复苏 (DNR) 订单的可能性和时间.
- 为了确定代码状态变化的人口预测因素在严重疾病的儿童.
主要方法:
- 一个单一中心的回顾性队列研究包括45,143名PICU患者 (2013年1月至2022年12月),不包括那些事先有DNR订单的患者.
- 后勤和考克斯回归模型分析了NELP和种族/种族与DNR订单的关联以及DNR的时间,并对诸如年龄和疾病严重程度等混因素进行了调整.
主要成果:
- 与英语偏好患者相比,患有NELP (西班牙语,阿拉伯语,其他) 患者的DNR订单放置率显著更高 (aORs1.81-3.59).
- 其他NELP患者也经历了更快的DNR安置时间 (aHR 1.77).
- 与非西班牙裔白人患者相比,非西班牙裔黑人患者的DNR订单的几率较低 (aOR 0.77).
结论:
- 非英语语言的偏好与在PICU中增加DNR订单的概率和更快的时机有关.
- 黑人种族是一个显著的预测者较低的DNR订单的几率.
- 人口因素,包括语言偏好和种族,是PICU中代码状态变化和终身护理轨迹的关键决定因素,需要进一步调查潜在机制.
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