Wang Han-Yi, Chew Ghee, Kung Chia-Te, Chung Kun-Jung, Lee Wen-Huei
Department of Emergency Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Chang Gung Med J. 2007 Sep-Oct;30(5):437-44.
To validate the use of the Charlson Comorbidity Index (CCI) for predicting admission of patients revisiting the Emergency Department (ED) within 72 hours.
Non-trauma patients aged above 17 years old who revisited an urban ED within 72 hours during January of 2004 were included in this retrospective observational study. Demographic data, diagnosis, CCI, in-hospital mortality rate and length of hospital stay were reviewed, and comparisons were made between the patients who were admitted or discharged on their return visits.
Of the 168 enrolled patients, 60 were admitted to a ward and 108 were discharged. Revisiting patients with high CCIs (> or = 2) had a higher admission rate (67.3% vs. 22.7%; p < 0.001) and an increased adjusted odds ratio of admission (odds ratio (OR) 2.06; 95% confidence interval (CI) 1.14-3.75) than low CCI patients. Admitted revisiting patients with high CCIs had poorer prognoses, longer hospital stays (11.79 +/- 8.92 days vs. 6.78 +/- 5.17 days; p < 0.05) and a higher in-hospital mortality rate (15.2% vs. 3.7%; p = 0.209).
CCI was well correlated with the admission possibility of patients revisiting the ED within 72 hours. More clinical management and discharge strategies should target those revisiting patients who have more comorbidities.
验证使用查尔森合并症指数（CCI）预测患者在72小时内再次就诊于急诊科（ED）时是否会入院。
本回顾性观察研究纳入了2004年1月期间在72小时内再次就诊于城市急诊科的17岁以上非创伤患者。回顾了人口统计学数据、诊断、CCI、住院死亡率和住院时间，并对复诊时入院或出院的患者进行了比较。
在168名纳入研究的患者中，60名被收入病房，108名出院。CCI高（≥2）的复诊患者入院率更高（67.3%对22.7%；p<0.001），与CCI低的患者相比，调整后的入院比值比增加（比值比（OR）2.06；95%置信区间（CI）1.14 - 3.75）。CCI高的复诊入院患者预后较差，住院时间更长（11.79±8.92天对6.78±5.17天；p<0.05），住院死亡率更高（15.2%对3.7%；p = 0.209）。
CCI与患者在72小时内再次就诊于急诊科时的入院可能性密切相关。更多的临床管理和出院策略应针对合并症更多的复诊患者。
