The Investigation of Clinical Characteristics and Outcomes of ICU Readmission among Elderly Patients

老年病人重返加護病房的臨床特性及預後之探討

蔡季倫(Chi-Lun Tsai) ； 方楸淑(Chiu-Shu Fang) ； 丁靜宜(Ching-I Ting) ； 楊俊杰(Chung-Chieh Yang) ； 陳志金(Che-Kim Tan) ； 陳奇祥(Khee-Siang Chan)

《中華民國急救加護醫學會雜誌》 23卷2期 (2012/06) Pp. 47-55

https://doi.org/10.30018/JECCM.201206.0001

摘要

研究背景：病人「重返加護病房」是反映加護病房照護品質的重要指標。病人重返加護病房，不但增加醫療費用造成醫療浪費，而且延長病人的住院天數，造成病患死亡率及罹病率增加。然而，有關老年病人重返加護病房的研究卻鮮少被提及和討論。為了解老年重症病人重返加護病房之臨床特性及相關的結果，本論文將針對這項目的做深入的探討。研究方法：以回溯性方法於2003年在台灣某醫學中心具79床之加護病房收集年齡超過65歲以上的老年人。以病歷回顧的方式記錄病患的臨床特性及結果。同時也進一步的比較重返加護病房的病人中死亡與存活者的差異。研究結果：老年病人加護病房的重返率為12.0%。其中83名為男性，占了56.5%。研究個案的平均年齡為74.7 ± 6.1歲。呼吸道問題為老年病人重返加護病房的最主要原因，占了所有重返原因的46.4%。而老年病人重返加護病房的死亡率為38.1%。在重返加護病房的個案中，死亡的個案有較高的APACHE II（25.8 ± 9.5 vs. 19.1 ± 7.8, p=0.036）及TISS分數（29.3 ± 9.4 vs. 23.1 ± 6.7, p=0.019），然而其GCS分數（9.6± 6.7 vs. 11.6 ± 13.4, p=0.002）卻是較低的。至於住院天數方面，死亡個案在重返加護病房時有較長的加護病房住院天數（11.6 ± 13.4 vs. 9.6 ± 6.7, p=0.002），但在住院的總天數方面，卻較存活個案為短（38.6±28.3 vs. 55.4 ± 55.9, p=0.010）。多變項分析顯示重返加護病房時的APACHE II（勝算比為1.085, 95%信賴區間為1.003-1.172, p=0.041）及TISS分數（勝算比為1.114, 95%信賴區間為1.040-1.193, p=0.002）為老年病人重返加護病房的危險相關因子。研究結論：老年病人重返加護病房有較高的死亡率及罹病率。老年病人重返加護病房時，其疾病嚴重度愈高表示病患有著較高的死亡率。在重返加護病房的原因中，以呼吸道疾病為最主要的原因。至於如何辨別高危險群病人，降低老年病人加護病房重返率，為未來必要的研究重點。

關鍵字

老年 ； 重返 ； 加護病房 ； 臨床特性 ； 結果 ； 死亡率

並列摘要

Background: ICU readmission has been identified as a reliable performance indicator for intensive care. ICU readmission not only increases medical expenditure and prolongs the length of the hospital stay, but it also increases the mortality and morbidity of patients. However, ICU readmission of elderly patients has rarely been investigated. To address this issue, our aim was to delineate the clinical characteristics and outcomes of ICU readmission among elderly patients.Materials and Methods: Patients who were aged 65 years or above and admitted more than once to the ICU during the same hospitalization were retrospectively collected for the year 2003 from a medical ICU and a surgical ICU with a total of 79 beds at a tertiary care center. Clinical characteristics and outcomes were recorded. The risk factors associated with mortality on ICU readmission were evaluated.Results: The ICU readmission rate among the elderly patients was 12.0%. Eighty-three (56.5%) of these patients were male. The average age was 74.7 ± 6.1 years. Respiratory disease (46.3%) was the most common diagnosis among the elderly patients who were readmitted. The mortality rate was 38.1%. The non-survivors had significantly higher APACHE II scores (25.8 ± 9.5 vs. 19.1 ± 7.8, p=0.036) and therapeutic intervention scoring system (TISS) scores (29.3 ± 9.4 vs. 23.1 ± 6.7, p=0.019), but had a lower GCS (9.8 ± 5.1 vs. 11.7 ± 3.6, p＜0.001) during ICU readmission. The length of ICU stay was significantly longer for the ICU readmitted non-survivors group (11.6 ± 13.4 vs. 9.6 ± 6.7, p=0.002). In addition, the length of hospital stay was longer for the survivor group (55.4 ± 55.9 vs. 38.6 ±28.3, p=0.010). Multivariate analysis showed that the APACHE II scores (odds ratio 1.085, 95% confidence interval 1.003-1.172, p=0.041) and TISS scores (odds ratio 1.114, 95% confidence interval 1.040-1.193, p=0.002) on ICU readmission were the two risk factors associated with mortality.Conclusions: ICU readmission is associated with a high mortality and morbidity rate among elderly patients. The severity of the disease during readmission is correlated with the higher mortality of these patients. Respiratory disease was the major reason for ICU readmission. Strategies for reducing ICU readmission and improving the outcome among the elderly patients should be highlighted and studied further.

並列關鍵字

elderly ； readmission ； intensive care unit ； clinical characteristic ； outcomes ； mortality rate