Gunnarsdottir Oddny S, Rafnsson Vilhjalmur
Office of Education, Research and Development, Landspitali University Hospital, Reykjavik, Iceland.
J Emerg Med. 2010 Apr;38(3):286-92. doi: 10.1016/j.jemermed.2007.09.061. Epub 2008 Jul 26.
Approximately 20% of Emergency Department (ED) users discharged home receive a non-causative discharge diagnosis in the category of "Symptoms, signs, abnormal findings, and ill-defined causes," according to the International Classification of Diseases. The objective of this study was to evaluate the association of these non-causative discharge diagnoses with mortality in general and with violent death and suicide in particular. This is a prospective study; the primary source of data was computer records from the ED at Landspitali University Hospital, Hringbraut, Reykjavik, Iceland over the period 1995-2001. The main discharge diagnoses were recorded according to the International Classification of Diseases. Individuals with a non-causative discharge diagnosis were followed-up for cause-specific mortality through national registries by record linkage and were compared to national mortality rates and the rates of those with causative physical diagnoses. The standardized mortality ratios, hazard ratios, and 95% confidence intervals (CI) were calculated. The data on individuals with a non-causative discharge diagnosis from the ED revealed that the standardized mortality ratio for all causes was 1.57 (95% CI 1.39-1.77) among men and 1.83 (95% CI 1.61-2.08) among women. The hazard ratio for violent death was 1.64 (95% CI 1.07-2.52) and for suicide 2.08 (95% CI 1.02-4.24), adjusted for age and gender, among individuals with a non-causative discharge diagnosis compared to those having causative physical discharge diagnoses. Through analysis of the discharge diagnoses "Symptoms, signs, abnormal findings and ill-defined causes," this study has identified an association between the group of patients discharged from the ED with a non-causative diagnosis who are at high risk of suicide and who may, through further studies, become subjects for suicide prevention strategies.
根据国际疾病分类，约20%从急诊科出院回家的患者被诊断为“症状、体征、异常发现及病因不明”，这类诊断并非导致患者前来就诊的真正病因。本研究旨在评估这些非病因性出院诊断与总体死亡率，尤其是暴力死亡和自杀之间的关联。这是一项前瞻性研究；数据的主要来源是冰岛雷克雅未克市兰斯皮塔利大学医院急诊科1995年至2001年期间的计算机记录。主要出院诊断依据国际疾病分类进行记录。对有非病因性出院诊断的个体，通过国家登记处进行记录链接，追踪其特定病因死亡率，并与全国死亡率以及有病因性身体诊断的患者死亡率进行比较。计算标准化死亡率、风险比和95%置信区间（CI）。急诊科有非病因性出院诊断的个体数据显示，男性所有病因的标准化死亡率为1.57（95%CI 1.39 - 1.77），女性为1.83（95%CI 1.61 - 2.08）。在调整年龄和性别后，有非病因性出院诊断的个体与有病因性身体出院诊断的个体相比，暴力死亡的风险比为1.64（95%CI 1.07 - 2.52），自杀的风险比为2.08（95%CI 1.02 - 4.24）。通过对“症状、体征、异常发现及病因不明”这一出院诊断的分析，本研究发现，从急诊科出院且诊断为非病因性的患者群体存在自杀高风险，通过进一步研究，这些患者可能成为自杀预防策略的对象。
