Friedmann P D, Jin L, Karrison T G, Hayley D C, Mulliken R, Walter J, Chin M H
Division of General Internal Medicine, Department of Medicine, Brown University School of Medicine, Providence, RI, USA.
Am J Emerg Med. 2001 Mar;19(2):125-9. doi: 10.1053/ajem.2001.21321.
The purpose of this study to determine predictors of revisit, hospital admission, or death among older patients discharged from the emergency department (ED). We performed a prospective study of patients aged 65 or older in an urban ED. The primary outcomes were ED revisit, hospital admission, or death 30 or 90 days after discharge from an index ED visit. Of the 463 eligible patients, 75 (16%) experienced ED revisit, hospitalization, or death within 30 days, and 125 (27%) within 90 days. In multivariate proportional hazards models, physical functioning and mental health in the lowest tertile, and lack of supplemental insurance predicted revisit, hospitalization, or death within 30 days after ED discharge. Poor physical functioning, missing mini-mental state examination, comorbidity, and ambulance transport to the initial ED visit predicted 90-day outcome. Problems with physical functioning, mental health and supplemental insurance are potentially remediable precursors of early morbidity among older patients after ED discharge. Future research should examine whether addressing these issues among the elderly population will lessen ED return visits, hospitalization, and mortality.
本研究旨在确定急诊科（ED）出院的老年患者再次就诊、住院或死亡的预测因素。我们对一家城市急诊科65岁及以上的患者进行了一项前瞻性研究。主要结局是首次急诊科就诊出院后30天或90天内的急诊科再次就诊、住院或死亡。在463名符合条件的患者中，75名（16%）在30天内经历了急诊科再次就诊、住院或死亡，125名（27%）在90天内经历了上述情况。在多变量比例风险模型中，身体功能和心理健康处于最低三分位数以及缺乏补充保险可预测急诊科出院后30天内的再次就诊、住院或死亡。身体功能差、未进行简易精神状态检查、合并症以及初次急诊科就诊时乘坐救护车可预测90天的结局。身体功能、心理健康和补充保险方面的问题是急诊科出院后老年患者早期发病的潜在可补救的先兆。未来的研究应探讨解决老年人群中的这些问题是否会减少急诊科复诊、住院和死亡率。
