Olsson Thomas, Terent Andreas, Lind Lars
Department of Internal Medicine, Uppsala University, Akademiska sjukhuset.
Eur J Emerg Med. 2005 Oct;12(5):220-4. doi: 10.1097/00063110-200510000-00004.
To investigate whether co-existing medical disorders, summed up in a comorbidity index, in nonsurgical patients attending the emergency department could predict short-term and long-term mortality, and whether the index could add prognostic information to the Rapid Emergency Medicine Score.
This was a prospective cohort study. In all, 885 nonsurgical patients, presenting to an adult emergency department and admitted to a medical department of a 1200-bed university hospital during 2 months, were enrolled consecutively. The Rapid Emergency Medicine Score (including blood pressure, oxygen saturation, respiratory rate, pulse rate, age and Glasgow coma scale) was calculated within 20 min in all those admitted to the emergency department. The history of coexisting disorders (Charlson Comorbidity Index) was collected from the medical records.
In a univariate analysis, the Charlson Comorbidity Index could predict both short-term and long-term mortality in nonsurgical emergency department patients. An increase of one point in the 16-point Charlson Comorbidity Index scale was associated with a hazard ratio of 1.15 (95% CI 1.04-1.28, P<0.0001) for 7-day mortality and 1.28 (95% CI 1.23-1.33, P<0.0001) for 5-year mortality. The Rapid Emergency Medicine Score could also predict both short-term and long-term mortality (hazard ratio for an increase of one point in the 26-point Rapid Emergency Medicine Score scale was 1.33 (95% CI 1.28-1.39, P<0.0001) for 7-day mortality and 1.25 (95% CI 1.22-1.28, P<0.0001) for 5-year mortality. The Charlson Comorbidity Index could also add prognostic information to the Rapid Emergency Medicine Score as a predictor of long-term mortality, but it could not independently predict short-term (3-day, 7-day) mortality when forced into the same multivariate logistic model as the Rapid Emergency Medicine Score (hazard ratio for one point increase in the Charlson Comorbidity Index was 1.20 for 5-year mortality (95% CI 1.15-1.25, P<0.0001).
Information on coexisting disorders (Charlson Comorbidity Index) can prognosticate both short-term and long-term mortality in the nonsurgical emergency department. It can also add prognostic information to the Rapid Emergency Medicine Score as a predictor of long-term mortality.
探讨在急诊科就诊的非手术患者中，用合并症指数汇总的并存疾病是否能预测短期和长期死亡率，以及该指数是否能为快速急诊医学评分增加预后信息。
这是一项前瞻性队列研究。总共连续纳入了885例非手术患者，这些患者在2个月内前往一家拥有1200张床位的大学医院的成人急诊科就诊，并被收治到内科。所有入住急诊科的患者均在20分钟内计算快速急诊医学评分（包括血压、血氧饱和度、呼吸频率、脉搏率、年龄和格拉斯哥昏迷量表）。从病历中收集并存疾病的病史（查尔森合并症指数）。
在单因素分析中，查尔森合并症指数可以预测非手术急诊科患者的短期和长期死亡率。查尔森合并症指数16分制量表中每增加1分，7天死亡率的风险比为1.15（95%置信区间1.04 - 1.28，P<0.0001），5年死亡率的风险比为1.28（95%置信区间1.23 - 1.33，P<0.0001）。快速急诊医学评分也可以预测短期和长期死亡率（26分制快速急诊医学评分量表中每增加1分，7天死亡率的风险比为1.33（95%置信区间1.28 - 1.39，P<0.0001），5年死亡率的风险比为1.25（95%置信区间1.22 - 1.28，P<0.0001）。作为长期死亡率的预测指标，查尔森合并症指数也可以为快速急诊医学评分增加预后信息，但当与快速急诊医学评分纳入同一多变量逻辑模型时，它不能独立预测短期（3天、7天）死亡率（查尔森合并症指数每增加1分，5年死亡率的风险比为1.20（95%置信区间1.15 - 1.25，P<0.0001）。
并存疾病的信息（查尔森合并症指数）可以预测非手术急诊科患者的短期和长期死亡率。作为长期死亡率的预测指标，它也可以为快速急诊医学评分增加预后信息。
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