Background and importance 

Delayed admission to the ICU is reported to be associated with worse outcomes in cancer patients.

Objective 

The main objective of this study was to compare the 180-day survival of cancer patients whether they were directly admitted to the ICU from the emergency department (ED) or secondarily from the wards after the ED visit.

Design, settings and participants 

This was a retrospective observational study including all adult cancer patients that visited the ED in 2018 and that were admitted to the ICU at some point within 7 days from the ED visit.

Exposure 

Delayed ICU admission.

Outcome measure and analysis 

Survival at day 180 was plotted using Kaplan–Meier curves, and hazard ratio (HR) from Cox proportional-hazard models was used to quantify the association between admission modality (directly from the ED or later from wards) and survival at day 180, after adjustment to baseline characteristics.

Results 

During the study period, 4560 patients were admitted to the hospital following an ED visit, among whom 136 (3%) patients had cancer and were admitted to the ICU, either directly from the ED in 101 (74%) cases or secondarily from the wards in 35 (26%) cases. Patients admitted to the ICU from the ED had a better 180-day survival than those admitted secondarily from wards (log-rank P = 0.006). After adjustment to disease status (remission or uncontrolled malignancy), survival at day 180 was significantly improved in the case of admission to the ICU directly from the ED with an adjusted HR of 0.50 (95% confidence interval, 0.26–0.95), P = 0.03.

Conclusion 

In ED patients with cancer, a direct admission to the ICU was associated with better 180-day survival compared with patients with a delayed ICU admission secondary from the wards. However, several confounders were not taken into account, which limits the validity of this result.

中文翻译：

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延迟入住重症监护病房对癌症患者急诊就诊后生存的影响：一项回顾性观察研究

背景和重要性 

据报道，延迟入住 ICU 与癌症患者的预后较差有关。

客观的 

本研究的主要目的是比较癌症患者的 180 天生存率，无论他们是从急诊科 (ED) 直接入住 ICU 还是在 ED 就诊后从病房继而入住。

设计、设置和参与者 

这是一项回顾性观察研究，包括所有在 2018 年就诊 ED 并在 ED 就诊后 7 天内入住 ICU 的成年癌症患者。

接触 

延迟入住 ICU。

结果测量和分析 

使用 Kaplan-Meier 曲线绘制第 180 天的存活率，并使用 Cox 比例风险模型的风险比 (HR) 来量化入院方式（直接来自 ED 或稍后来自病房）与第 180 天后的存活率之间的关联。调整基线特征。

结果 

在研究期间，4560 名患者在 ED 就诊后入院，其中 136 名 (3%) 患者患有癌症并被 ICU 收治，其中 101 名 (74%) 病例直接来自 ED 或次要来自病房 35 (26%) 例。从 ED 入住 ICU 的患者的 180 天生存期比从病房二次入住的患者更好（对数秩P = 0.006）。在调整疾病状态（缓解或未控制的恶性肿瘤）后，直接从 ED 进入 ICU 的情况下，第 180 天的生存率显着提高，调整后的 HR 为 0.50（95% 置信区间，0.26-0.95），P = 0.03。

结论 

在患有癌症的 ED 患者中，与从病房继发延迟入住 ICU 的患者相比，直接入住 ICU 与更好的 180 天生存率相关。然而，几个混杂因素没有被考虑在内，这限制了这个结果的有效性。