Utilization of a rapid response team and associated outcomes in patients with malignancy
1
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Background: Recent advances in diagnosis and treatment have improved long-term outcomes in cancer patients. As a result, the requirement for a rapid response team (RRT) for cancer patients is also increasing. This study aimed to analyze utilization of an RRT and the associations between related factors and mortality in a population of cancer patients. Methods: This retrospective cohort study included hospitalized patients at a single academic medical center in Seoul, Korea, who required RRT activation during a 6-year period from June 2013 to December 2018. Results: Overall, 164 of the 457 patients who met the above criteria were cancer patients, and they had a significantly higher Charlson comorbidity score than the non-cancer patients (5.0 vs. 7.0, P<0.001). A significantly larger proportion of cancer patients required intensive care unit transfer (51.8% vs. 41.0%, P=0.032). Cancer patients also had significantly higher in-hospital mortality compared with other patients (39.6% vs. 10.9%, P<0.001). Furthermore, presence of cancer was independently associated with in-hospital mortality (adjusted odds ratio [OR], 2.09; 95% confidence interval [CI], 1.11 to 3.93). Among cancer patients, higher Acute Physiology and Chronic Health Evaluation (APACHE) II at the time of RRT activation was significantly associated with in-hospital mortality regardless of malignancy (adjusted OR, 1.08; 95% CI, 1.01 to 1.15). Conclusions: Cancer patients requiring RRT activation have significantly higher rates of inhospital mortality than patients not using RRT. Higher severity score at the time of RRT activation in patients with malignancy was significantly associated with in-hospital mortality.
Abstract
Background: Recent advances in diagnosis and treatment have improved long-term outcomes in cancer patients. As a result, the requirement for a rapid response team (RRT) for cancer patients is also increasing. This study aimed to analyze utilization of an RRT and the associations between related factors and mortality in a population of cancer patients. Methods: This retrospective cohort study included hospitalized patients at a single academic medical center in Seoul, Korea, who required RRT activation during a 6-year period from June 2013 to December 2018. Results: Overall, 164 of the 457 patients who met the above criteria were cancer patients, and they had a significantly higher Charlson comorbidity score than the non-cancer patients (5.0 vs. 7.0, P<0.001). A significantly larger proportion of cancer patients required intensive care unit transfer (51.8% vs. 41.0%, P=0.032). Cancer patients also had significantly higher in-hospital mortality compared with other patients (39.6% vs. 10.9%, P<0.001). Furthermore, presence of cancer was independently associated with in-hospital mortality (adjusted odds ratio [OR], 2.09; 95% confidence interval [CI], 1.11 to 3.93). Among cancer patients, higher Acute Physiology and Chronic Health Evaluation (APACHE) II at the time of RRT activation was significantly associated with in-hospital mortality regardless of malignancy (adjusted OR, 1.08; 95% CI, 1.01 to 1.15). Conclusions: Cancer patients requiring RRT activation have significantly higher rates of inhospital mortality than patients not using RRT. Higher severity score at the time of RRT activation in patients with malignancy was significantly associated with in-hospital mortality.
참고문헌 (26)
- Devita MA, "Findings of the first consensus conference on medical emergency teams", Crit Care Med, 34, pp.2463~2478 (2006)
- Bellomo R, "A prospective before-and-after trial of a medical emergency team", Med J Aust, 179, pp.283~287 (2003)
- Chen J, "The relationship between early emergency team calls and serious adverse events", Crit Care Med, 37, pp.148~153 (2009)
- Buist MD, "Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital : preliminary study", BMJ, 324, pp.387~390 (2002)
- Jones D, "Long term effect of a medical emergency team on cardiac arrests in a teaching hospital", Crit Care, 9, pp.R808~R815 (2005)
- Maharaj R, "Rapid response systems : a systematic review and meta-analysis", Crit Care, 19, pp.254~ (2015)
- Chan PS, "Rapid response teams : a systematic review and meta-analysis", Arch Intern Med, 170, pp.18~26 (2010)
- Winters BD, "Rapid response systems : a systematic review", Crit Care Med, 35, pp.1238~1243 (2007)
- Brenner H, "Long-term survival rates of cancer patients achieved by the end of the 20th century : a period analysis", Lancet, 360, pp.1131~1135 (2002)
- Azoulay E, "Intensive care of the cancer patient : recent achievements and remaining challenges", Ann Intensive Care, 1, pp.5~ (2011)
- Song JU, "Early intervention on the outcomes in critically ill cancer patients admitted to intensive care units", Intensive Care Med, 38, pp.1505~1513 (2012)
- Austin CA, "Utilization of rapid response resources and outcomes in a comprehensive cancer center", Crit Care Med, 42, pp.905~909 (2014)
- Jones D, "The rapid response system and end-of-life care", Curr Opin Crit Care, 19, pp.616~623 (2013)
- Dargin JM, "Resource utilization and end-of-life care in a US hospital following medical emergency team-implemented do not resuscitate orders", J Hosp Med, 9, pp.372~378 (2014)
- Charlson ME, "A new method of classifying prognostic comorbidity in longitudinal studies : development and validation", J Chronic Dis, 40, pp.373~383 (1987)
- Lee A, "The medical emergency team", Anaesth Intensive Care, 23, pp.183~186 (1995)
- Jones D, "Clinical deterioration in cancer patients : the role of the rapid response team", Crit Care Med, 42, pp.997~998 (2014)
- Needham DM, "A systematic review of the Charlson comorbidity index using Canadian administrative databases : a perspective on risk adjustment in critical care research", J Crit Care, 20, pp.12~19 (2005)
- Staudinger T, "Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit", Crit Care Med, 28, pp.1322~1328 (2000)
- Taccone FS, "Characteristics and outcomes of cancer patients in European ICUs", Crit Care, 13, pp.R15~ (2009)
- Knaus WA, "APACHE II : a severity of disease classification system", Crit Care Med, 13, pp.818~829 (1985)
- Xing X, "Performance of three prognostic models in patients with cancer in need of intensive care in a medical center in China", PLoS One, 10, pp.e0131329~ (2015)
- Abbott RR, "APACHE II : prediction of outcome of 451 ICU oncology admissions in a community hospital", Ann Oncol, 2, pp.571~574 (1991)
- Hillman K, "Introduction of the medical emergency team(MET)system : a cluster-randomised controlled trial", Lancet, 365, pp.2091~2097 (2005)
- Coventry C, "Rapid response team calls to patients with a pre-existing not for resuscitation order", Resuscitation, 84, pp.1035~1039 (2013)
- Sebat F, "Effect of a rapid response system for patients in shock on time to treatment and mortality during 5 years", Crit Care Med, 35, pp.2568~2575 (2007)