RESUMO
OBJECTIVES: To estimate resource consumption and the extent of futile care among patients admitted to the pediatric intensive care unit (PICU). STUDY DESIGN: A prospective cohort study of 353 consecutive admissions followed for 1334 patient-days during the PICU stay at the Texas Children's Hospital in Houston, Texas. Participants were 353 children and adolescents who were hospitalized in the PICU during September and October 1993. Three broad operational definitions of futility were developed to capture the maximum extent of resource consumption related to medical futility. Definition 1 (imminent demise futility) was developed by an objective, validated, severity of illness measure (Pediatric Risk of Mortality Score) to identify patients with high mortality risks. Definition 2 (lethal condition futility) was used to identify patients in the PICU whose long-term survival was unlikely. Definition 3 (qualitative futility) was used to identify patients with high morbidity. Resource consumption was measured according to the number of patient-days in the PICU and the Therapeutic Intervention Scoring System. RESULTS: Twenty-three (6.5%) patients representing 36 (2.7%) patient-days met at least one of the definitions of medical futility for some of the days when they were in the PICU. None of the patient-days that met any of the definitions of medical futility were associated with high resource consumption compared with non-futile care patient-days. CONCLUSIONS: Despite our use of broad definitions of medical futility, relatively small amounts of resources were used in futile PICU care. This suggests that attempts to reduce resource consumption in the PICU by focusing on medical futility are unlikely to be successful.
Assuntos
Recursos em Saúde/economia , Unidades de Terapia Intensiva Pediátrica/economia , Futilidade Médica , Alocação de Recursos , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Mortalidade Hospitalar , Humanos , Lactente , Tempo de Internação/economia , Cuidados para Prolongar a Vida/economia , Masculino , Estudos Prospectivos , Índice de Gravidade de Doença , Análise de Sobrevida , Texas , Resultado do TratamentoRESUMO
Data from Trinidad and Tobago suggest there is a positive role for the ATLS program in Third World countries. Between 1970-1979 traffic accidents increased from 16,433 to 28,003 while deaths increased from 179 to 252 per year. Sixty-nine per cent of deaths were adult males mainly between 20-30 years old and most fatal accidents occurred between 6:00 and 10:00 p.m. particularly on weekends. Because expert consultants are not always immediately available within the hospital, initial trauma resuscitation is provided by emergency room physicians. Accordingly, 75% of trauma deaths occur in hospital with 65% of those dying within six hours of reaching the hospital alive. Compared to a similar sized North American population the death to injury ratio is at least doubled. The beneficial impact of the ATLS program in Third World countries is assured if ATLS quality control is maintained and can be assessed, as outlined, by comparing pre ATLS with post ATLS data.