Boockvar Kenneth S, Gruber-Baldini Ann L, Burton Lynda, Zimmerman Sheryl, May Conrad, Magaziner Jay
Geriatrics Research, Education and Clinical Center, Bronx Veterans Affairs Medical Center, Bronx, New York.
J Am Geriatr Soc. 2005 Apr;53(4):590-6. doi: 10.1111/j.1532-5415.2005.53205.x.
To compare outcomes of infection in nursing home residents with and without early hospital transfer.
Observational cohort study.
Fifty-nine nursing homes in Maryland.
Two thousand one hundred fifty-three individuals admitted to nursing homes between 1992 and 1995.
Incident infection was recorded when a new infectious diagnosis was documented in the medical record or nonprophylactic antibiotic therapy was prescribed. Early hospital transfer was defined as transfer to the emergency department or admission to the hospital within 3 days of infection onset. Infection, resident, and facility characteristics were entered into a multivariate model to create a propensity score for early hospital transfer. Association between early hospital transfer and outcomes of infection, namely pressure ulcers and death between Days 4 and 34 after infection onset, were examined, controlling for propensity score.
Four thousand nine hundred ninety infections occurred in 1,301 residents. Genitourinary (28%), skin (19%), upper respiratory (13%), and lower respiratory (12%) were the most common types. Three hundred seventy-five episodes in which residents survived 3 days (7.6%) resulted in early hospital transfer. In multivariate regression, individuals with early hospital transfer had higher mortality (odds ratio (OR) 1.44, 95% confidence interval (CI)=1.04-1.99) and, in 1-month survivors, a greater occurrence of pressure ulcers (OR 1.61, 95% CI=1.17-2.20) than those without, after adjusting for propensity score.
Using observational data and propensity score methods, outcomes were worse in nursing home residents transferred to the hospital within 3 days of infection onset than in those who remained in the nursing home.
比较有早期医院转诊和没有早期医院转诊的疗养院居民的感染结局。
观察性队列研究。
马里兰州的59家疗养院。
1992年至1995年间入住疗养院的2153人。
当病历中有新的感染诊断记录或开具了非预防性抗生素治疗时，记录新发感染。早期医院转诊定义为在感染发作后3天内转至急诊科或入院。将感染、居民和机构特征纳入多变量模型，以创建早期医院转诊的倾向评分。在控制倾向评分的情况下，研究早期医院转诊与感染结局（即感染发作后第4天至第34天之间的压疮和死亡）之间的关联。
1301名居民发生了4990次感染。最常见的类型是泌尿生殖系统感染（28%）、皮肤感染（19%）、上呼吸道感染（13%）和下呼吸道感染（12%）。375例居民存活3天（7.6%）的情况导致早期医院转诊。在多变量回归中，调整倾向评分后，早期医院转诊的个体死亡率更高（优势比（OR）为1.44，95%置信区间（CI）=1.04-1.99），并且在1个月存活者中，压疮发生率更高（OR为1.61，95%CI=1.17-2.20）。
使用观察性数据和倾向评分方法，感染发作后3天内转至医院的疗养院居民的结局比留在疗养院的居民更差。
