Hazlett Sara B, McCarthy Melissa L, Londner Michael S, Onyike Chiadi U
Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD 21287, USA.
Acad Emerg Med. 2004 Feb;11(2):193-5.
To characterize psychiatric-related emergency department visits (PREDVs) among adults in the United States for the year 2000 and to analyze PREDV trends from 1992 to 2000.
Emergency department (ED) visit data from the National Hospital Ambulatory Medical Care Survey were used to estimate the number of PREDVs for adults aged 18 years and older. A PREDV was defined as any visit with a psychiatric discharge diagnosis (ICD N290- N312) or a suicide attempt (ICD E950-E959).
Approximately 4.3 million PREDVs occurred in the United States in the year 2000, yielding an annual rate of 21 visits per 1000 adults. The PREDV rates increased 15% between 1992 and 2000. The PREDVs accounted for 5.4% of all ED visits. Substance abuse (27%), neuroses (26%), and psychoses (21%) were the most common conditions. African Americans had significantly higher visit rates (29/1000; 95% CI = 27/1000 to 31/1000) compared with whites (23/1000; 95% CI = 22/1000 to 25/1000). Persons with Medicaid (66/1000; 95% CI = 64/1000 to 68/1000) had double the rate of PREDVs than the uninsured (33/1000; 95% CI = 31/1000 to 35/1000) and almost eight times the rate of those privately insured (8/1000; 95% CI = 7/1000 to 10/1000). Patients with psychiatric diagnoses had a higher admission rate (22%) than those with nonpsychiatric diagnoses (15%). The uninsured were the least likely to be admitted for all major psychiatric conditions except suicide (p < 0.0001).
Psychiatric-related ED visits represent a substantial and growing number of ED visits each year. Patient characteristics influence the likelihood of a PREDV. Further research is needed to better understand the role that hospital EDs play in the delivery of health care services to those with mental illness.
描述2000年美国成年人中与精神疾病相关的急诊科就诊情况（PREDV），并分析1992年至2000年期间PREDV的趋势。
使用来自国家医院门诊医疗调查的急诊科就诊数据，估算18岁及以上成年人的PREDV数量。PREDV定义为任何具有精神科出院诊断（国际疾病分类N290 - N312）或自杀未遂（国际疾病分类E950 - E959）的就诊。
2000年美国约发生430万次PREDV，成年人年发生率为每1000人中有21次就诊。1992年至2000年期间，PREDV发生率增加了15%。PREDV占所有急诊科就诊的5.4%。药物滥用（27%）、神经症（26%）和精神病（21%）是最常见的情况。与白人（23/1000；95%置信区间 = 22/1000至25/1000）相比，非裔美国人的就诊率显著更高（29/1000；9%置信区间 = 27/1000至31/1000）。医疗补助计划参保者（66/1000；95%置信区间 = 64/1000至68/1000）的PREDV发生率是未参保者（33/1000；95%置信区间 = 31/1000至35/1000）的两倍，几乎是私人保险参保者（8/1000；95%置信区间 = 7/1000至10/1000）的八倍。有精神科诊断的患者入院率（22%）高于非精神科诊断的患者（15%）。除自杀外，在所有主要精神疾病情况下，未参保者入院的可能性最小（p < 0.0001）。
与精神疾病相关的急诊科就诊每年占急诊科就诊的数量相当且不断增加。患者特征会影响PREDV的可能性。需要进一步研究以更好地了解医院急诊科在为精神疾病患者提供医疗服务中所起的作用。
