Pacientes con enfermedad crónica terminal en el servicio de emergencia de adultos de un hospital terciario: Patients with terminal chronic disease in the adult emergency Service of a tertiary hospital

Introduction: Patients with chronic terminal disease frequently come to emergency department of reference hospitals. Objectives: To determine frequency of chronic terminal disease in patients admitted to emergency department, identify invasive procedures and compare oncological with non-oncological patients. Methods: Cross-sectional study in patients older than 18 years old, admitted to emergency department of a tertiary hospital, November 2017. Criteria for terminal disease: Clinical stage IV cancer, severe cognitive deterioration or total functional dependence plus diagnosis of dementia, neurological sequelae, dependence of oxygen, glomerular filtration rate <30 ml / min, Child C cirrhosis, or left ventricular ejection fraction <20%. Statistical analysis with Mann-Whitney U and Chi square tests. Results:10.7% (172 of 1604 admissions) of admitted patients presented criteria of chronic terminal disease, with oncological cause 21.5% (37/172) and non-oncological 78.5% (135/172). In oncological patients, the median age was 70 years and was female 59.5%, while in non-oncological 84 years and 57% of women (p <0.01 and 0.79, respectively). 41% (71/172) were admitted by shock-trauma unit, more frequently due to drowsiness and dyspnea. Invasive procedures, probably unnecessary, were identified in 21.5% (37/172 patients), orotracheal intubation and central venous catheter for inotropic were the most frequent. The average stay in emergency department was eight days, with 32% of oncological deaths and 24% of non-oncological deaths in emergency department (p = 0.43). Conclusions: 10% of patients admitted to the emergency department of a tertiary hospital have chronic terminal disease, with a greater frequency of non-oncology, probably performing unnecessary procedures in one fifth of these.Introducción:Pacientes con enfermedad crónica terminal acuden con frecuencia a emergencia de hospitales de referencia. Objetivos: Determinar la frecuencia de enfermedad crónica terminal en pacientes admitidos a emergencia, identificar procedimientos invasivos y comparar oncológicos con no oncológicos. Métodos:Estudio de corte transversal, en mayores de 18 años admitidos a emergencia de un hospital terciario, noviembre 2017. Se consideró enfermedad terminal al cáncer en estadio clínico IV, deterioro cognitivo severo o dependencia funcional total más diagnóstico de demencia, secuela neurológica, dependencia de oxígeno, índice de filtración glomerular < 30 ml/min, cirrosis hepática Child C o fracción de eyección ventricular izquierda < 20%. Análisis estadístico con U de Mann-Whitney y Chi cuadrado. Resultados: El 10,7% (172 de 1604 admisiones) de los pacientes admitidos presentaron criterios de enfermedad crónica terminal, de causa oncológica 21,5% (37/172) y no oncológica 78,5% (135/172). En oncológicos la mediana de edad fue 70 años y sexo femenino 59,5%, mientras que en no oncológicos 84 años y 57% de mujeres (p<0,01 y 0,79 respectivamente). El 41% (71/172) ingresó por unidad de shock trauma, con mayor frecuencia por somnolencia y disnea. Se identificó procedimiento invasivos probablemente innecesarios en 21,5% (37/172 pacientes), intubación orotraqueal y catéter venoso central para inotrópicos fueron los más frecuentes. La estancia promedio en emergencia fue ocho días, falleciendo en emergencia 32% de oncológicos y 24% de no oncológicos (p=0,43). Conclusiones: El 10% de los pacientes admitidos a emergencia de un hospital terciario presenta enfermedad crónica terminal, con mayor frecuencia no oncológica, realizándose procedimientos probablemente innecesarios en la quinta parte de estos

Need for palliative care in patients admitted to emergency departments of three tertiary hospitals: evidence from a Latin-American city

Background: Emergency departments (ED) serve as a contact point for critically ill patients. According toexperience, a fraction of patients visiting ED present with symptoms and require palliative care; however,the prevalence of these patients has not been determined in Peru so far.Objectives: To estimate the prevalence of advanced disease in patients admitted to ED and identify amongthem the need for palliative care.Patients and methods: In the ED of 3 tertiary hospitals in Lima all adult patients had an evaluation ofthe medical history and an interview with patients or caregivers. The presence of multiple metastases wasconsidered advanced cancer, and dementia, neurological, respiratory, hepatic or cardiac disease with functionaldependence or severe deterioration for non-oncological illness. The screening tool was a validatedand adapted palliative care questionnaire.Results: The prevalence of advanced illness was 7.5% (60 of 797 admissions). The age of patients was19–96 (median 73.1) years of which 48.3% were females, 23 (39%) patients had oncological and 37 (61%)patients non-oncological diagnoses. The most frequent symptoms upon admission were dyspnoea, drowsiness,and pain. A total of 13 (21.7%) of patients with advanced disease were already receiving palliativecare and 8 (13.3%) had controlled symptoms.Conclusions: Nearly 1 in 13 patients attending ED of tertiary hospitals has advanced disease, of which80% reported the need for palliative care with less than a quarter of them having received it