Background

The aim of this study was to assess the benefit of direct ICU admission from the emergency department (ED) compared to admission from wards, in patients with hematological malignancies requiring critical care.

Methods

Post hoc analysis derived from a prospective, multicenter cohort study of 1011 critically ill adult patients with hematologic malignancies admitted to 17 ICU in Belgium and France from January 2010 to May 2011. The variable of interest was a direct ICU admission from the ED and the outcome was in-hospital mortality. The association between the variable of interest and the outcome was assessed by multivariable logistic regression after multiple imputation of missing data. Several sensitivity analyses were performed: complete case analysis, propensity score matching and multivariable Cox proportional-hazards analysis of 90-day survival.

Results

Direct ICU admission from the ED occurred in 266 (26.4%) cases, 84 of whom (31.6%) died in the hospital versus 311/742 (41.9%) in those who did not. After adjustment, direct ICU admission from the ED was associated with a decreased in-hospital mortality (adjusted OR: 0.63; 95% CI 0.45–0.88). This was confirmed in the complete cases analysis (adjusted OR: 0.64; 95% CI 0.45–0.92) as well as in terms of hazard of death within the 90 days after admission (adjusted HR: 0.77; 95% CI 0.60–0.99). By contrast, in the propensity score-matched sample of 402 patients, direct admission was not associated with in-hospital mortality (adjusted OR: 0.92; 95% CI 0.84–1.01).

Conclusions

In this study, patients with hematological malignancies admitted to the ICU were more likely to be alive at hospital discharge if they were directly admitted from the ED rather than from the wards. Assessment of early predictors of poor outcome in cancer patients admitted to the ED is crucial so as to allow early referral to the ICU and avoid delays in treatment initiation and mis-orientation.

中文翻译：

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急诊科直接进入重症监护病房，危重血液病患者的死亡率。

背景

这项研究的目的是评估在急需护理的血液系统恶性肿瘤患者中，急诊科（ED）直接ICU入院与病房入院相比的益处。

方法

事后分析源自一项前瞻性，多中心队列研究，该研究对2010年1月至2011年5月在比利时和法国接受ICU的1011名危重病成年恶性血液病成年患者进行了研究。关注的变量是ED和结果直接入ICU住院死亡率。在多次插补缺失数据后，通过多变量logistic回归评估目标变量与结果之间的关联。进行了几项敏感性分析：完整病例分析，倾向评分匹配和90天生存率的多变量Cox比例风险分析。

结果

急诊直接从ICU入院的病例为266（26.4％），其中84人（31.6％）在医院死亡，而未住院者为311/742（41.9％）。调整后，直接从急诊室就诊的ICU与降低的院内死亡率相关（校正后的OR：0.63； 95％CI 0.45-0.88）。完整的病例分析（校正后的OR：0.64； 95％CI 0.45-0.92）以及入院后90天内的死亡危险得到了证实（校正后的HR：0.77； 95％CI 0.60-0.99）。相比之下，在402例倾向得分匹配的样本中，直接入院与住院死亡率无关（校正OR：0.92； 95％CI 0.84–1.01）。

结论

在这项研究中，如果直接从急诊室而不是病房就诊，入住ICU的血液系统恶性肿瘤患者更有可能在医院出院。评估急诊入院的癌症患者预后不良的早期预测指标至关重要，这样可以尽早转诊至ICU并避免治疗开始和方向错误的延误。