Characteristics and outcomes of patients admitted to the acute palliative care unit from the emergency center.
BACKGROUND
Most patients admitted to acute palliative care units (APCUs) are transferred from inpatient oncology units. We hypothesized that patients admitted to APCUs from emergency centers (ECs) have symptom burdens and outcomes that differ from those of transferred inpatients.


OBJECTIVE
The purpose of this retrospective cohort study was to compare the symptom burdens and survival rate of patients admitted to an APCU from an EC with those of inpatients transferred to the APCU.


METHODS
Among the 2568 patients admitted to our APCU between September 1, 2003 and August 31, 2008, 312 (12%) were EC patients. We randomly selected 300 inpatients transferred to the APCU as controls (The outcome data were unavailable for two patients). We retrieved data on patient demographics, cancer diagnosis, Edmonton Symptom Assessment System scores, discharge outcomes, and overall survival from time of admission to the APCU.


RESULTS
The EC patients had higher rates of pain, fatigue, nausea, and insomnia and were less likely to be delirious. They were more than twice as likely to be discharged alive than transferred inpatients. Kaplan-Meier plot tests for product-limit survival estimate from admission to APCU for EC patients and inpatients were statistically significant (median survival 34 vs. 31 days, P<0.0001). In multivariate analysis, EC admission (odds ratio [OR]=1.8593, 95% confidence interval [CI] 1.1532-2.9961), dyspnea (OR=0.8533, 95% CI 0.7892-0.9211), well-being (OR=1.1192, 95% CI 1.0234-1.2257), and delirium (OR=0.3942, 95% CI 0.2443-0.6351) were independently associated with being discharged alive.


CONCLUSIONS
The EC patients have a higher acute symptom burden and are more likely to be discharged alive than transferred inpatients. The APCU was successful at managing symptoms and facilitating the discharge of both inpatients and EC patients to the community although the patients had severe symptoms on admission.
Department of Palliative Care and Rehabilitation Medicine, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
Seong Hoon
SH
Shin
Department of Palliative Care and Rehabilitation Medicine, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
David
D
Hui
Department of Biostatistics, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
Gary B
GB
Chisholm
Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University, Chuncheon, Republic of Korea.
Jung Hye
JH
Kwon
Department of Palliative Medicine, Clinica Universidad de Navarra, Pamplona, Spain.
Maria Teresa
MT
San-Miguel
Department of Palliative Care and Rehabilitation Medicine, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
Julio A
JA
Allo
Department of Palliative Care and Rehabilitation Medicine, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
Sriram
S
Yennurajalingam
Department of Palliative Care and Rehabilitation Medicine, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
Susan E
SE
Frisbee-Hume
Department of Palliative Care and Rehabilitation Medicine, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA. Electronic address: ebruera@mdanderson.org.
Eduardo
E
Bruera
D002173:Cancer Care Facilities / Q000706:statistics & numerical data*; D003422:Critical Care / Q000706:statistics & numerical data*; D003693:Delirium / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D004417:Dyspnea / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy*; D010166:Palliative Care / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data; D012189:Retrospective Studies
Acute palliative care unit; emergency center; symptom burden