RESUMEN
Background: This study aims to identify any effect of frailty in altering the risk of death or poor outcome already associated with receipt of organ support on ICU. It also aims to assess the performance of mortality prediction models in frail patients. Methods: All admissions to a single ICU over 1-year were prospectively allocated a Clinical Frailty Score (CFS). Logistic regression analysis was used to investigate the effect of frailty on death or poor outcome (death/discharge to a medical facility). Logistic regression analysis, area under the Receiver Operator Curve (AUROC) and Brier scores were used to investigate the ability of two mortality prediction models, ICNARC and APACHE II, to predict mortality in frail patients. Results: Of 849 patients, 700 (82%) patients were not frail, and 149 (18%) were frail. Frailty was associated with a stepwise increase in the odds of death or poor outcome (OR for each point rise of CFS = 1.23 ([1.03-1.47]; p = .024) and 1.32 ([1.17-1.48]; p = <.001) respectively). Renal support conferred the greatest odds of death and poor outcome, followed by respiratory support, then cardiovascular support (which increased the odds of death but not poor outcome). Frailty did not modify the odds already associated with organ support. The mortality prediction models were not modified by frailty (AUROC p = .220 and .437 respectively). Inclusion of frailty into both models improved their accuracy. Conclusions: Frailty was associated with increased odds of death and poor outcome, but did not modify the risk already associated with organ support. Inclusion of frailty improved mortality prediction models.
Asunto(s)
Antiinfecciosos/administración & dosificación , Líquido Ascítico/microbiología , Servicios Médicos de Urgencia/métodos , Unidades de Cuidados Intensivos , Laparotomía/métodos , Monitoreo Intraoperatorio/métodos , Prescripciones de Medicamentos , Servicio de Urgencia en Hospital , Humanos , Laparotomía/efectos adversosRESUMEN
INTRODUCTION: Witnessing traumatic experiences can cause post-traumatic stress disorder (PTSD). The true impact on healthcare staff of attending in-hospital cardiac arrests (IHCAs) has not been studied. This cross-sectional study examined cardiac arrest debriefing practices and the burden of attending IHCAs on nursing and medical staff. METHODS: A 33-item questionnaire-survey was sent to 517 doctors (of all grades), nurses and health-care assistants (HCAs) working in the emergency department, the acute medical unit and the intensive care unit of a district general hospital between April and August 2018. There were three sections: demographics; cardiac arrest and debriefing practices; trauma-screening questionnaire (TSQ). RESULTS: The response rate was 414/517 (80.1%); 312/414 (75.4%) were involved with IHCAs. Out of 1463 arrests, 258 (17.6%) were debriefed. Twenty-nine of 302 (9.6%) staff screened positively for PTSD. Healthcare assistants and Foundation Year 1 doctors had higher TSQ scores than nurses or more senior doctors (pâ¯=â¯0.02, pâ¯=â¯0.02, respectively). Debriefing was not associated with PTSD risk (pâ¯=â¯0.98). Only 8/67 (11.9%) of resuscitation leaders had prior debriefing training. CONCLUSIONS: Nearly 10% of acute care staff screened positively for PTSD as a result of attending an IHCA, with junior staff being most at risk of developing trauma symptoms. Very few debriefs occurred, possibly because of a lack of debrief training amongst cardiac arrest team leaders. More support is required for acute care nursing and medical staff following an IHCA.