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首页> 外文期刊>Southern African Journal of Critical Care >Variation in timing of decisions to withdraw life-sustaining treatment in adult ICU patients from three centres in different geographies: Do clinical factors explain the difference?
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Variation in timing of decisions to withdraw life-sustaining treatment in adult ICU patients from three centres in different geographies: Do clinical factors explain the difference?

机译：在不同地区三个中心提取成人ICU患者的决策时间的变化：临床因素解释差异吗？

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BACKGROUND: Decisions to withdraw life-sustaining treatment (WLST) are common in intensive care units (ICUs). Clinical and non-clinical factors are important, although the extent to which each plays a part is uncertain.OBJECTIVES: To determine whether the timing of decisions to WLST varies between ICUs in a single centre in three countries and whether differences in timing are explained by differences in clinical decision-making.METHODS: The study involved a convenience sample of three adult ICUs - one in each of the UK, USA and South Africa (SA). Data were prospectively collected on patients whose life-sustaining treatment was withdrawn over three months. The timing of decisions was collected, as were patients' premorbid functional status and illness severity 24 hours prior to decision to WLST. Multivariate analysis was used to identify factors associated with decisions to WLST. Clinicians participated in interviews involving hypothetical case studies devoid of non-clinical factors.RESULTS: Deaths following WLST accounted for 23% of all deaths during the study period at the USA site v. 37% (UK site) and 70% (SA site) (p0.0010 across the three sites). Length of stay (LOS) prior to WLST decision varied between sites. Controlling for performance status, age, and illness severity, study site predicted LOS prior to decision (p0.0010). In the hypothetical cases, LOS prior to WLST was higher for USA clinicians (p0.017).CONCLUSION: There is variation in the proportion of ICU patients in whom WLST occurs and the timing of these decisions between sites; differences in clinical decision-making may explain the variation observed, although clinical and non-clinical factors are inextricably linked.
机译：背景：提取寿命持续治疗（WLST）的决定在重症监护单位（ICU）中是常见的。临床和非临床因素是重要的，尽管每个人发挥作用的程度是不确定的。目的：确定在三个国家的单一中心的ICU中对WLST的决策的时间是否有所不同，以及是否解释了时序的差异临床决策的差异。方法：该研究涉及三个成人ICU的便利样本 - 在英国，美国和南非（SA）中的每一个。对寿命治疗撤出三个月的患者进行了预期收集数据。决定的时间是在决定前24小时的患者的预血官能状态和疾病严重程度。多变量分析用于识别与WLST的决策相关的因素。临床医生参与了涉及非临床因素的假设案例研究的面试。结果：WLST后死亡人员在美国现场研究期间占所有死亡人员的23％。37％（英国网站）和70％（SA网站） （三个地点P <0.0010）。在WLST决策之前的逗留时间（LOS）在站点之间变化。控制性能状态，年龄和疾病严重程度，研究网站在决定之前预测LOS（P <0.0010）。在假设病例中，WLST之前的LOS适用于美国临床医生（P <0.017）。结论：ICU患者的比例发生了变化，其中WLST发生以及位点之间的这些决定的定时;临床决策的差异可以解释所观察到的变异，尽管临床和非临床因素是密不可分的。

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