중환자실 입실 우선순위 결정에 따른 입실환자와 입실거절환자의 예후 비교 = Triage Decision For ICU Admission And Patients’ Outcome

다국어 초록 (Multilingual Abstract)

Background: We constructed a prospective study to evaluate the outcome of patients referred to an intensivist for ICU admission as well as the factors associated with ICU admission refusal.
Methods: Patients referred for ICU admission to medico-surgical ICU in our hospital for 16 weeks were included in this study. We classified the reasons for refusal into three categories: inappropriate referral; triage; futility. Also we classified admitted patients into two categories: immediate admission; delayed admission. After initial evaluation of a patient by an intensivist, we checked the patient's outcome for following 28 days.
Results: 632 patients had been referred for ICU admission during study period. Among them, 445 (70%) patients were admitted and 187 (30%) patients were refused ICU admission. 116 patients were refused because of inappropriate referral, 52 for triage and 19 for futility. 394 patients were admitted immediately and 51 were refused initially but were later admitted. When 116 inappropriate referral patients were excluded, the mortality rates for immediate admission, delayed admission and triage/futility were 14.4%, 39.2% and 56.3%, respectively (P ＜ 0.05). Standardized mortality ratio was 0.70 for immediate admission, 1.20 for delayed admission, 1.28 for triage and 1.30 for futility (P ＜ 0.05). The factors associated with refusal for ICU admission were age, medical division, diagnostic group and high Mortality Probability Model II0 (MPM II0) grades.
Conclusions: Because the triage decision for ICU admission influences the patients’ outcome, an intensivist must carefully come to a decision when admitting patients to ICU by considering the appropriate guidelines for ICU admission and triage.

참고문헌 (Reference)

1 "Triaging patients to the ICU:a pilot study of factors influencing admission decisions and patient outcomes" 29 : 774-81, 2003

2 "Triage Decision for ICU admission and patients outcome The 23rd Scientific Congress of the KSCCM and the 3rd Joint Congress of Korean- Japanese Intensivists" 2003

3 "Survival of critically ill patients hospitalized in and out of intensive care units under paucity of intensive care units beds" 32 : 1654-60, 2004

4 "Recent innovations in intensive care unit risk prediction models" Curr Opin Crit Care 8 : 321-30, 2002

5 "Rationing of intensive care unit services" 225 : 1143-6, 1986

6 "Rationing intensive care-physician responses to a resource shortage" 309 : 1155-60, 1983

7 "Prospective evaluation of patients refused admission to an intensive care unit" 1459-65, 2001

8 "Mortality probability models(MPM II)based on an international cohort of intensive care patients" 270 : 2478-86, 1993

9 "Guidelines for intensive care unit admission,discharge,and triage" 27 : 633-38, 1999

10 "Evaluation of triage decisions for intensive care admission" 27 : 1073-9, 1999

11 "Compliance with triage to intensive care recommendations" 29 : 2132-6, 2001

12 "Civilian triage in the intensive care unit:the ritual of the last bed" 21 : 598-606, 1993