演題抄録

International Session(Poster)

開催概要
開催回
第51回・2013年・京都
 

Characteristics of APCU patients admitted from the Emergency Center

演題番号 : ISP-30

[筆頭演者]
Seong Hoon Shin:1 
[共同演者]
Eduardo Bruera:2、David Hui:2、Gary B Chisholm:2、Jung Hye Kwon:3、San-Miguel T Maria:4、Allo A Julio:2、Sriram Yennurajalingam:2、Susan E Frisbee-Hume :2

1:Department of Internal Medicine, College of Medicine, Kosin University, Busan, Korea、2:Department of Palliative Care and Rehabilitation Medicine, MD Anderson Cancer Center, USA、3:Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University, Chuncheon, Korea、4:Department of Palliative Medicine, Clinica Universidad de Navarra, Spain

 

Background: Most patients admitted to Acute Palliative Care Unit (APCU) are transferred from inpatient oncology units. We hypothesized that Emergency Center (EC) admissions have different symptom burden and outcomes compared to Inpatient Transfer (IP) patients.Objectives: In this retrospective cohort study, we compared the symptom burden and survival between the EC and IP groups. Methods: Among all 2568 patients admitted to our APCU between September 1, 2003 and August 31, 2008, 312 (12%) were EC patients. We randomly selected 298 IP patients as controls. We retrieved the patient demographics, cancer diagnosis, Edmonton Symptom Assessment Scale (ESAS), discharge outcomes, and overall survival from time of admission. Results: EC patients were more like to be black (22% v 11%, p=0.0006) and less likely to have hematologic cancer (5% v 14%, p=0.0003). EC patients had higher pain (5.4 v 4.6, p=0.0004), fatigue (6.7 v 6.1, p=0.0049), nausea (2.7 v 1.6, p<0.0001), insomnia (4.8 v 4.2, p=0.03) and were less likely to be delirious (41% v 55%, p=0.001). EC patients had more public insurance (44% v 38%, p=0.0142), more home discharge (29% v 11%, p=0.0001), longer admission (8 v 7 days, p=0.0002), and were 2.3x as likely to be discharged alive as compared to IP patients (p<0.0001, Wald Chi-square test). Kaplan-Meier plots and log-rank test for Survival from admission of APCU for EC and IP groups were not statistically significant (Median survival after admission were 34 v 31 days, p=0.08). In multivariate analysis, EC admission (OR= 1.9, 1.2-3.0), wellbeing (OR=1.12, 1.02-1.23), dyspnea (OR=0.85, 0.79-0.92) and delirium (OR=0.39, 0.24-0.64) were independently significant for being discharge alive. The c-statistic value was 0.71.Conclusion: EC patients have higher acute symptom burden, but more likely to be discharged alive as compared to IP transfer patients. The APCU is successful at managing symptoms and facilitating discharge to the community for EC patients.

前へ戻る