| Objective Exploring the clinical distribution characteristics and related influencing factors of hospitalized death patients is to provide decision support for hospital administrators to scientifically formulate disease prevention and control strategies and rationally allocate medical resources,and to provide reference for medical staff to understand the key points of death risk management and improve clinical nursing work.Methods 1921 patients who died during hospitalization in a tertiary hospital in Zunyi City from 2013 to 2017 were included in the study by convenience sampling method.A self-designed questionnaire was used to retrospectively collect the data of patient's sex,age,marital status,place of residence,length of hospital stay,rescue times,operation or not,comorbidity situation,cause of death,time of death,department of death,and whether life support before death was limited,to analyze the high-risk links of clinical distribution of hospitalized death patients.Then,according to whether there were different degrees of abandonment of life support treatment measures and signing of relevant medical documents in the medical records before death,patients were divided into two groups: life support limited group(955 cases)and unrestricted group(966 cases),and univariate and multivariate factors were used to analyze the influencing factors of life support limitations before death.Results(1)The overall characteristics,regularities and trends of death in this hospital: A total of 1921 deaths occurred in the hospital in the last five years,with an average mortality rate of 0.34%,and the mortality rate decreased year by year(P<0.05).Among the 1921 death patients: 1.The sex ratio of male to female mortality was 2.02:1,and the mortality rate of male was higher than that of female(P<0.05).2.The average age of death was 55.40 years old,the median age was 62(42,75)years old.The age of 60 years old or above was the high incidence age of death(54.50%),and the mortality rate was significantly higher than other age groups(P<0.05).3.The top five causes of death comprised more than 80% of the total,including circulatory diseases(24.83%),tumors(23.06%),injuries and poisoning(16.14%),respiratory diseases(11.76%)and digestive diseases(6.45%).There were significant differences in the distribution of causes of death between urban and rural areas,sex and age(P<0.05),among which tumors and injuries were the first causes of death in urban areas and rural areas;there were differences in the composition of causes of death between men and women,but the top five causes of death were consistent;with the increase of age,the main causes of death changed from congenital malformation,deformation and chromosomal abnormalities to injuries and poisoning to NCD.4.The cumulative causes of death of the top five single diseases accounted for 32.95%,followed by intracranial injury(9.21%),lung cancer(8.17%),coronary heart disease(5.78%),pneumonia(5.00%)and cerebral hemorrhage(4.79%).The first single cause of death of the top five systemic diseases was coronary heart disease(23.27%),lung cancer(35.44%),intracranial injury(57.10%),pneumonia(42.48%)and liver fibrosis(21.77%).5.ICU is a high-risk department with the highest death toll of 745 cases(38.78%)and the highest mortality rate of 15.99%(P<0.05).Among the general departments,the top five death tolls were cardiovascular surgery,respiratory medicine,oncology,emergency department and neurosurgery,with a cumulative composition of 29.62%.However,the mortality rates of the top five departments were slightly different,followed by cardiovascular surgery,minimally invasive interventional surgery,neurosurgery,hematology and emergency department,and the mortality rates were 2.77%,1.07%,0.75%,0.69%,respectively(P<0.05).6.The distribution of death season and month found that the number of deaths in spring and winter was higher than that in summer and autumn,but there was no significant difference in mortality rate between different seasons(P>0.05).The number of deaths in March was the highest(9.53%)and in September was the lowest(6.92%).The difference in mortality between different months was statistically significant(P<0.05),and the mortality rate from January to March was higher than other months.Patients with respiratory diseases showed a higher number of deaths from January to April than in other months,and patients with circulatory diseases were slightly higher than other months from November to May.7.The distribution of 24-hour death time found that the peak time of death was 9:00-11:00 a.m and 16:00-17:00 p.m in hospitalized patients,and there was a small peak at 7:00 a.m.The time distribution trends of death in different years,diseases,departments and death modes were different.Among them,there were death peaks in day and night in each year,and the peak of death in 2013 was mainly nighttime,and the peak of death with the increase of the year has a tendency to change to daytime.8.The hospitalization time distribution showed that the average hospital stay was 18 days and the median hospital stay was 8(2,19)days.The maximum number of deaths in hospitals within 1 to 6 days was 566(29.46%),and the number of deaths over 30 days was at least 273(14.21%).The distribution of hospitalization time for patients of different ages,diseases types and medical payment methods has their own trends and characteristics.9.Finally,the comorbidity showed that 56.90% of the patients with death had other diseases,and the more the combined diseases were,the longer the hospitalization time was(P<0.05).The most common comorbidities were hypertension(25.35%),diabetes(13.07%),cerebral infarction(11.97%),chronic renal insufficiency(9.94%)and coronary heart disease(8.80%).There were significant differences in ages and causes of death between the numbers and types of comorbidities(P<0.05).Only 5.88% of the patients aged 5-14 years had comorbidities,77.27% of the patients aged 60 years and over had one or more diseases,80% of the patients with injury and poisoning had no comorbidities,and 80% of the patients with respiratory diseases had at least one comorbidity.(2)Influencing factors of life support limitation in hospitalized death patients: The data showed that 966 patients(50.29%)died after the rescue failed,and 955(49.71%)died after life support was limited.Univariate analysis showed that the difference between the two groups was statistically significant in terms of age,place of residence,operations or not,rescue times,numbers of comorbidities,length of hospital stay,hospitalization costs,medical payment methods and disease types(P<0.05).Logistic regression showed that age,place of residence,operations or not,rescue times,medical payment methods and disease types were important factors in choosing to abandon life support treatment before death.Among them,the elderly,urban residents,patients who did not undergo surgical treatment,and patients who did not undergo rescue were more likely to give up life support treatment;compared with patients with medical insurance,patients with public medical care were less likely to give up life support treatment(P<0.05);compared with patients with circulatory system diseases,cancer patients were 3.968 times more likely to give up life support treatment than patients with circulatory system diseases(P<0.05).Conclusions(1)The distribution of hospitalized death patients in sex,age,disease,complications,departments,months,day and night time has certain characteristics and particularities.Hospitals should adopt predictive medical and nursing strategies in high-risk links to improve the quality of clinical work and reduce the risk of death.(2)The proportion of hospitalized dead patients who choose to give up life support treatment in different degrees during their deathbed period is 49.71%.Age,place of residence,operations or not,rescue times,medical payment methods and disease types are important influencing factors affecting patients and their families to choose to give up life support treatment. |
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