Blaivas M, Sierzenski P, Plecque D, Lambert M
Department of Emergency Medicine, Christ Hospital and Medical Center, Oak Lawn, IL, USA.
Acad Emerg Med. 2000 Sep;7(9):988-93. doi: 10.1111/j.1553-2712.2000.tb02088.x.
To determine whether patients presenting to the emergency department (ED) with first-trimester pregnancy complications have a decreased length of stay (LOS) when a live intrauterine pregnancy (IUP) is diagnosed by emergency physicians (EPs).
This study was performed at an urban community ED with a residency program and an annual census of 65,000. A retrospective chart review from October 1995 to August 1998 identified 1,419 patients who received ultrasound examinations confirming live IUP in the first trimester with pain and/or bleeding. Two hundred seventy-seven of these patients received their ultrasound examinations from EPs; 1, 142 patients received a study from radiology and were not scanned by EPs. The LOSs for the two groups were compared and defined as the time from being placed into a room to discharge from the ED. Significance was determined using a two-tailed t-test. Median times with confidence intervals were calculated.
When patients had a live IUP confirmed by an EP, the median LOS was 21% (59 min) less than those who received an ultrasound examination by radiology (p = 0.0001; 95% CI = 49 min to 1 hr 17 min). When evaluated by time of day, patients who presented after hours (6 PM to 6 AM) and were scanned by EPs spent 28% (1 hr 17 min) less time in the ED (p = 0.0001; 95% CI = 55 min to 1 hr 37 min).
Emergency physicians identifying live IUP with bedside ultrasonography significantly decreased patients' LOSs in the ED. The decrease in LOS was most apparent for patients presenting during evening and nighttime hours.
确定因孕早期妊娠并发症前往急诊科（ED）就诊的患者，在急诊医师（EP）诊断为宫内活胎妊娠（IUP）时，其住院时间（LOS）是否会缩短。
本研究在一家设有住院医师培训项目且年接诊量为65000人次的城市社区急诊科进行。对1995年10月至1998年8月期间的病历进行回顾性分析，确定了1419例因疼痛和/或出血接受超声检查确诊为孕早期宫内活胎的患者。其中277例患者由急诊医师进行超声检查；1142例患者接受放射科检查，未由急诊医师进行扫描。比较两组的住院时间，定义为从进入病房到从急诊科出院的时间。采用双侧t检验确定显著性。计算中位数时间及其置信区间。
当患者经急诊医师确诊为宫内活胎时，其住院时间中位数比接受放射科超声检查的患者短21%（59分钟）（p = 0.0001；95%置信区间 = 49分钟至1小时17分钟）。按就诊时间评估，夜间（下午6点至上午6点）就诊并由急诊医师进行扫描的患者在急诊科的停留时间短28%（1小时17分钟）（p = 0.0001；95%置信区间 = 55分钟至1小时37分钟）。
急诊医师通过床边超声检查识别宫内活胎可显著缩短患者在急诊科的住院时间。住院时间的缩短在夜间就诊的患者中最为明显。
