斯里兰卡农村地区自我中毒患者的医院转诊模式：对估算发展中国家自我中毒发病率的启示
Patterns of hospital transfer for self-poisoned patients in rural Sri Lanka: implications for estimating the incidence of self-poisoning in the developing world.
作者信息
Eddleston Michael, Sudarshan K, Senthilkumaran M, Reginald K, Karalliedde Lakshman, Senarathna Lalith, de Silva Dhammika, Rezvi Sheriff M H, Buckley Nick A, Gunnell David
机构信息
South Asian Clinical Toxicology Research Collaboration, Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, England.
出版信息
Bull World Health Organ. 2006 Apr;84(4):276-82. doi: 10.2471/blt.05.025379. Epub 2006 Apr 13.
OBJECTIVES
Most data on self-poisoning in rural Asia have come from secondary hospitals. We aimed to: assess how transfers from primary to secondary hospitals affected estimates of case-fatality ratio (CFR); determine whether there was referral bias according to gender or poison; and estimate the annual incidence of all self-poisoning, and of fatal self-poisoning, in a rural developing-world setting.
METHODS
Self-poisoning patients admitted to Anuradhapura General Hospital, Sri Lanka, were reviewed on admission from 1 July to 31 December 2002. We audited medical notes of self-poisoning patients admitted to 17 of the 34 surrounding peripheral hospitals for the same period.
FINDINGS
A total of 742 patients were admitted with self-poisoning to the secondary hospital; 81 died (CFR 10.9%). 483 patients were admitted to 17 surrounding peripheral hospitals. Six patients (1.2%) died in peripheral hospitals, 249 were discharged home, and 228 were transferred to the secondary hospital. There was no effect of gender or age on likelihood of transfer; however, patients who had ingested oleander or paraquat were more likely to be transferred than were patients who had taken organophosphorus pesticides or other poisons. Estimated annual incidences of self-poisoning and fatal self-poisoning were 363 and 27 per 100,000 population, respectively, with an overall CFR of 7.4% (95% confidence interval 6.0-9.0).
CONCLUSION
Fifty per cent of patients admitted to peripheral hospitals were discharged home, showing that CFRs based on secondary hospital data are inflated. However, while incidence of self-poisoning is similar to that in England, fatal self-poisoning is three times more common in Sri Lanka than fatal self-harm by all methods in England. Population based data are essential for making international comparisons of case fatality and incidence, and for assessing public health interventions.
目标
亚洲农村地区大多数关于自我中毒的数据都来自二级医院。我们旨在：评估从基层医院转诊至二级医院如何影响病死率（CFR）的估计值；确定是否存在基于性别或毒物的转诊偏倚；并估计农村发展中地区所有自我中毒以及致命性自我中毒的年发病率。
方法
对2002年7月1日至12月31日期间入住斯里兰卡阿努拉德普勒综合医院的自我中毒患者进行入院时审查。我们审核了同期周边34家基层医院中17家医院收治的自我中毒患者的病历。
研究结果
共有742例自我中毒患者入住二级医院；81例死亡（病死率10.9%）。483例患者入住周边17家基层医院。6例患者（1.2%）在基层医院死亡，249例出院回家，228例被转诊至二级医院。性别或年龄对转诊可能性没有影响；然而，摄入夹竹桃或百草枯的患者比摄入有机磷农药或其他毒物的患者更有可能被转诊。自我中毒和致命性自我中毒的估计年发病率分别为每10万人口363例和27例，总体病死率为7.4%（95%置信区间6.0 - 9.0）。
结论
入住基层医院的患者中有50%出院回家，这表明基于二级医院数据的病死率被高估。然而，虽然自我中毒的发病率与英国相似，但斯里兰卡致命性自我中毒的发生率是英国所有方法导致的致命性自我伤害发生率的三倍。基于人群的数据对于进行病死率和发病率的国际比较以及评估公共卫生干预措施至关重要。
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