Caterino Jeffrey M, Hiestand Brian C, Martin Daniel R
Department of Emergency Medicine, The Ohio State University, Means Hall, 1654 Upham Drive, Columbus, OH 43210, USA .
BMC Emerg Med. 2008 Apr 30;8:6. doi: 10.1186/1471-227X-8-6.
The goals of the study were to assess the relationship between age and processes of care in emergency department (ED) patients admitted with pneumonia and to identify independent predictors of failure to meet recommended quality care measures.
This was a prospective cohort study of a pre-existing database undertaken at a university hospital ED in the Midwest. ED patients > or =18 years of age requiring admission for pneumonia, with no documented use of antibiotics in the 24 hours prior to ED presentation were included. Compliance with Pneumonia National Quality Measures was assessed including ED antibiotic administration, antibiotics within 4 hours, oxygenation assessment, and obtaining of blood cultures. Odds ratios were calculated for elders and non-elders. Logistic regression was used to identify independent predictors of process failure.
One thousand, three hundred seventy patients met inclusion criteria, of which 560 were aged > or =65 years. In multiple variable logistic regression analysis, age > or =65 years was independently associated with receiving antibiotics in the ED (odds ratio [OR] = 2.03, 95% CI 1.28-3.21) and assessment of oxygenation (OR = 2.10, 95% CI, 1.18-3.32). Age had no significant impact on odds of receiving antibiotics within four hours of presentation (OR 1.10, 95% CI 0.84-1.43) or having blood cultures drawn (OR 1.02, 95%CI 0.78-1.32). Certain other patient characteristics were also independently associated with process failure.
Elderly patients admitted from the ED with pneumonia are more likely to receive antibiotics while in the ED and to have oxygenation assessed in the ED than younger patients. The independent association of certain patient characteristics with process failure provides an opportunity to further increase compliance with recommended quality measures in admitted patients diagnosed with pneumonia.
本研究的目的是评估肺炎急诊入院患者的年龄与护理流程之间的关系，并确定未能达到推荐质量护理措施的独立预测因素。
这是一项对中西部一家大学医院急诊科现有数据库进行的前瞻性队列研究。纳入年龄≥18岁、因肺炎需要入院且在急诊科就诊前24小时内无抗生素使用记录的急诊科患者。评估了肺炎国家质量指标的依从性，包括急诊科抗生素使用、4小时内使用抗生素、氧合评估和血培养采集。计算了老年人和非老年人的比值比。使用逻辑回归来确定流程失败的独立预测因素。
1370名患者符合纳入标准，其中560名年龄≥65岁。在多变量逻辑回归分析中，年龄≥65岁与在急诊科接受抗生素治疗（比值比[OR]=2.03，95%可信区间1.28-3.21）和氧合评估（OR=2.10，95%可信区间1.18-3.32）独立相关。年龄对就诊后4小时内接受抗生素治疗的几率（OR 1.10，95%可信区间0.84-1.43）或进行血培养的几率（OR 1.02，95%可信区间0.78-1.32）没有显著影响。某些其他患者特征也与流程失败独立相关。
与年轻患者相比，因肺炎从急诊科入院的老年患者在急诊科更有可能接受抗生素治疗并进行氧合评估。某些患者特征与流程失败的独立关联为进一步提高诊断为肺炎的入院患者对推荐质量指标的依从性提供了机会。
