Loran M J, McErlean M, Eisele G, Raccio-Robak N, Verdile V P
Department of Emergency Medicine, Albany Medical College, NY 12208, USA.
Clin Nephrol. 2002 Jun;57(6):439-43. doi: 10.5414/cnp57439.
To describe the emergency department (ED) presentation, evaluation and disposition of maintenance hemodialysis (HD) patients.
A retrospective review of adult HD patients seen 1/1-12/31/97. The following was collected: demographics, mode of arrival, chief complaint, etiology of renal failure, evaluation, treatment, disposition, length of stay and facility charges. During the study period, this tertiary care ED had an annual adult census of 45,000. No clinical pathways were in place.
143 patients made 355 visits: 351 charts were available. Mean patient age was 51 (range 20-86), 62% were male, 51% were white. 70% presented from home, 26% from dialysis. EMS transported 32%. Medicare insured 78%. Etiologies of renal failure included hypertension (33%), diabetes (27%), HIV (7%) and glomerulonephritis (8%). Complaints were related to infection (18%), dyspnea (17%), vascular access (16%). chest pain or dysrhythmia (15%) and gastrointestinal complaints (12%). ED evaluation included CBC (79%), electrolytes (75%), CXR (57%) and EKG (48%). Antibiotics were administered to 21%. HD was performed earlier than scheduled in 14%. Two hundred and eighteen patients (62%) were admitted (ICU 11%, telemetry 22%), 19 (5%) refused admission and 2 expired in the ED. The average hospital length of stay was 7.8 days (range 1-59), with 29% hospitalized more than 1 week, compared to 6.54 days for non-HD patients. The mean facility charge for admitted subjects was $14,758, while the average cost for non-HD admissions was $7,152. Of the 133 patients (38%) who were discharged directly from the ED, the mean length stay was 223 minutes (range 30 to 750) and the mean charge was $658. The mean length of stay for non-HD patients was 124 minutes.
The ED evaluation of adult HD patients involves multiple diagnostic modalities, and patients are usually admitted. The admit rate, ED length of stay for discharged patients and hospital charges for care were substantially higher in the HD patients than in the general population. Further research in the ED care of these complex patients should be undertaken.
描述维持性血液透析（HD）患者在急诊科（ED）的就诊情况、评估及处置。
回顾性分析1997年1月1日至12月31日期间就诊的成年HD患者。收集以下信息：人口统计学资料、到达方式、主要症状、肾衰竭病因、评估、治疗、处置、住院时间及医疗费用。在研究期间，这家三级医疗急诊科的成年患者年普查人数为45000人。当时未制定临床路径。
143例患者就诊355次，获取了351份病历。患者平均年龄51岁（范围20 - 86岁），62%为男性，51%为白人。70%从家中前来就诊，26%从透析中心前来。32%由急救医疗服务（EMS）转运。78%患者有医疗保险。肾衰竭病因包括高血压（33%）、糖尿病（27%）、艾滋病病毒（HIV）感染（7%）及肾小球肾炎（8%）。主要症状与感染（18%）、呼吸困难（17%）、血管通路问题（16%）、胸痛或心律失常（15%）以及胃肠道症状（12%）有关。急诊科评估包括血常规（CBC）检查（79%）、电解质检查（75%）、胸部X线检查（CXR）（57%）及心电图（EKG）检查（48%）。21%患者使用了抗生素。14%患者血液透析时间比预定时间提前。218例患者（62%）住院（11%入住重症监护病房，22%入住遥测病房），19例（5%）拒绝住院，2例在急诊科死亡。平均住院时间为7.8天（范围1 - 59天），29%患者住院超过1周，而非HD患者平均住院时间为6.54天。住院患者的平均医疗费用为14758美元，非HD住院患者的平均费用为7152美元。133例（38%）直接从急诊科出院的患者，平均住院时间为223分钟（范围30至750分钟），平均费用为658美元。非HD患者的平均住院时间为124分钟。
急诊科对成年HD患者的评估涉及多种诊断方式且患者通常住院。HD患者的住院率、出院患者的急诊科住院时间及医疗费用显著高于普通人群。应对这些复杂患者在急诊科的治疗进行进一步研究。
