Patients with End-stage Oncologic and Nononcologic Disease in Emergency Service of an Urban Tertiary Hospital

Abstract

Contexto: En las últimas décadas, los pacientes con enfermedades crónicas terminales han tenido visitas más frecuentes a los servicios de emergencia.

Objetivos: Este estudio tiene como objetivo determinar la proporción de enfermedad terminal en pacientes reingresados ​​a urgencias, evaluar el uso de este servicio y la tasa de mortalidad.

Ambientación y diseño: Estudio transversal en un hospital terciario con 120 camillas que reporta anualmente 160 mil atenciones y 22 mil ingresos.

Sujetos y métodos: Se incluyeron pacientes de 18 años o más que fueron readmitidos en urgencias. Se entrevistó al paciente y / o cuidador; Se revisó la historia clínica y se realizó un seguimiento de 1 año. El cáncer terminal se determinó mediante confirmación histológica en el estadio IV y la enfermedad terminal no oncológica mediante dependencia funcional total (índice de Katz) o deterioro cognitivo severo (cuestionario de Pfeiffer) además de insuficiencia orgánica avanzada. Conclusiones: La enfermedad terminal es frecuente en los pacientes reingresados ​​a urgencias, más de tipo no oncológico. Estos pacientes acuden con frecuencia al servicio de urgencias, con alta mortalidad (más elevada en oncológicos).

Context: In the last decades, patients with chronic terminal diseases have had more frequent visits to emergency services. Aims: This study aims to determine the proportion of terminal illness in patients readmitted to emergency room, to evaluate the use of this service and rate of death. Settings and Design: A cross-sectional study in a tertiary hospital with 120 stretchers which annually reports 160 thousand attentions and 22 thousand admissions. Subjects and Methods: Included 18-year-old patients or older who were readmitted to emergency room. Patient and/or caregiver were interviewed; medical record was reviewed and made 1-year follow-up. Terminal cancer was determined by histologically confirmation in Stage IV and nononcologic terminal disease by total functional dependence (Katz index) or severe cognitive impairment(Pfeiffer questionnaire) in addition of advanced organ failure. Statistical Analysis Used: Fisher’s exact and U of Mann–Whitney tests for two independent samples. Results: Ninety-two (26%) of 349 were readmissions; 29 (36.7%) of 79 evaluated patients were identifying with terminal disease. Eleven (38%) of them had cancer (genitourinary in 64%). Nononcologic terminal disease was identified in 18 cases(62%) (Neurodegenerative involvement in 50%). More frequent symptoms were dyspnea 41%, mental confusion 24%, and pain 21%. Terminal patients had 6.2 (standard deviation 8.2) emergency visits at last year, being admitted 48,6% of these visits. Six‑month mortality rate was 73 and 61% in oncologic and nononcolgic patients, respectively (P < 0.05). Conclusions: End-stage disease is frequent in readmitted patients to emergency, more of nononcologic kind. These patients use frequently emergency service, with high mortality (more elevated in oncologic).