Govindarajan Anand, Schull Michael
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Ann Emerg Med. 2003 Apr;41(4):481-90. doi: 10.1067/mem.2003.108.
The effect of socioeconomic status on out-of-hospital care has not been widely examined. We determine whether socioeconomic status was associated with out-of-hospital transport delays for patients with chest pain.
A retrospective study of patients with chest pain transported by means of ambulance in Toronto, Ontario, Canada, in 1999 was conducted. The primary outcome measure was the 90th percentile system response interval, with secondary outcomes being the 90th percentile on-scene interval, transport interval, and total out-of-hospital interval. Socioeconomic status was the primary independent variable. Covariates were age, sex, case severity, dispatch and return priority, time and day of transport, paramedic training, and percentage of high-rise apartments in the region.
Four thousand three hundred fifty-six patients met the inclusion criteria. The 90th percentile system response interval and total out-of-hospital interval were 11 minutes and 49 minutes, respectively. In multivariate analyses, the highest socioeconomic status neighborhoods were significantly associated with decreased system response interval (34.0 seconds; 95% confidence interval [CI] 6.2 to 70.9 seconds) and transport interval (132.3 seconds; 95% CI 24.1 to 229.6 seconds). In addition, age (+45.3 seconds per 10 years; 95% CI 13.3 to 75.1 seconds), female sex (+205.0 seconds; 95% CI 78.1 to 287.7 seconds), and advanced care paramedic crews (+371.6 seconds; 95% CI 263.3 to 490.1 seconds) were associated with delays in total out-of-hospital interval. Lastly, calls originating from the highest socioeconomic status neighborhoods were dispatched the highest proportion of advanced care paramedic crews, despite similar dispatch priorities and case severities.
High socioeconomic status neighborhoods were associated with shorter out-of-hospital transport intervals for patients with chest pain. In addition, out-of-hospital delays were associated with age, sex, and advanced care paramedic crew type, with calls from the highest socioeconomic status neighborhoods being most likely to receive advanced care paramedic crews.
社会经济地位对院外护理的影响尚未得到广泛研究。我们确定社会经济地位是否与胸痛患者的院外转运延迟相关。
对1999年在加拿大安大略省多伦多市通过救护车转运的胸痛患者进行回顾性研究。主要结局指标是第90百分位数的系统响应间隔，次要结局指标是第90百分位数的现场间隔、转运间隔和总院外间隔。社会经济地位是主要自变量。协变量包括年龄、性别、病例严重程度、调度和返回优先级、转运时间和日期、护理人员培训以及该地区高层公寓的比例。
4356名患者符合纳入标准。第90百分位数的系统响应间隔和总院外间隔分别为11分钟和49分钟。在多变量分析中，社会经济地位最高的社区与系统响应间隔缩短（34.0秒；95%置信区间[CI]6.2至70.9秒）和转运间隔缩短（132.3秒；95%CI24.1至229.6秒）显著相关。此外，年龄（每10岁增加45.3秒；95%CI13.3至75.1秒）、女性（增加205.0秒；95%CI78.1至287.7秒）和高级护理人员团队（增加371.6秒；95%CI263.3至490.1秒）与总院外间隔延迟相关。最后，尽管调度优先级和病例严重程度相似，但来自社会经济地位最高社区的呼叫派出高级护理人员团队的比例最高。
社会经济地位高的社区与胸痛患者较短的院外转运间隔相关。此外，院外延迟与年龄、性别和高级护理人员团队类型相关，来自社会经济地位最高社区的呼叫最有可能接收高级护理人员团队。
