Rowe Brian H, Voaklander Donald C, Wang Dongsu, Senthilselvan Ambikaipakan, Klassen Terry P, Marrie Thomas J, Rosychuk Rhonda J
Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada.
School of Public Health, University of Alberta, Edmonton, AB, Canada.
Chest. 2009 Jan;135(1):57-65. doi: 10.1378/chest.07-3041. Epub 2008 Aug 8.
Asthma is a widespread disease with a prevalence of approximately 7 to 10% in adults. Exacerbations are common in the emergency department (ED) setting. The objective of this study was to describe the epidemiology of asthma presentations to EDs made by adults in the province of Alberta, Canada.
The Ambulatory Care Classification System of Alberta and provincial administrative databases were used to obtain all ED encounters for asthma during 6 fiscal years (April 1999 to March 2005). Information extracted included demographics, ED visit timing, and subsequent visits to non-ED settings. Data analysis included descriptive summaries and directly standardized visit rates.
There were 105,813 ED visits for asthma made by 48,942 distinct adults, with an average of 2.2 visits per individual. Most patients (66%) had only one asthma-related ED visit. Female patients (61.2%) presented more commonly than male patients. The gender- and age-standardized visit rates declined from 9.7/1,000 in 1999/2000 to 6.8/1,000 in 2004/2005. The welfare and Aboriginal subsidy groups had larger age-specific ED visits rates than other populations. Important daily, weekly, and monthly trends were observed. Hospital admission occurred in 9.8% of the cases; 6.4% had a repeat ED visit within 7 days. Overall, 67.4% of individuals had yet to have a non-ED follow-up visit by 1 week. The estimated median time to the first follow-up visit was 19 days (95% confidence interval, 18 to 21).
Asthma is a common presenting problem in Alberta EDs, and further study of these trends is required to understand the factors associated with the variation in presentations. The important findings include an overall decrease in the rates of presentation over the study period, disparities based on age, gender, and socioeconomic/cultural status, and the low rate of early follow-up. Targeted interventions could be implemented to address specific groups and reduce asthma-related visits to Alberta EDs.
哮喘是一种广泛存在的疾病，在成年人中的患病率约为7%至10%。在急诊科（ED）环境中，哮喘加重很常见。本研究的目的是描述加拿大艾伯塔省成年人到急诊科就诊的哮喘流行病学情况。
使用艾伯塔省门诊护理分类系统和省级行政数据库，获取6个财政年度（1999年4月至2005年3月）期间所有因哮喘到急诊科就诊的记录。提取的信息包括人口统计学数据、急诊科就诊时间以及随后到非急诊科环境就诊的情况。数据分析包括描述性总结和直接标准化就诊率。
48942名不同的成年人因哮喘到急诊科就诊105813次，平均每人就诊2.2次。大多数患者（66%）仅有一次与哮喘相关的急诊科就诊。女性患者（61.2%）就诊比男性患者更常见。性别和年龄标准化就诊率从1999/2000年的9.7/1000下降到2004/2005年的6.8/1000。福利和原住民补贴群体的特定年龄急诊科就诊率高于其他人群。观察到重要的每日、每周和每月趋势。9.8%的病例住院治疗；6.4%的患者在7天内再次到急诊科就诊。总体而言，67.4%的个体在1周内尚未进行非急诊科的随访就诊。首次随访就诊的估计中位时间为19天（95%置信区间，18至21天）。
哮喘是艾伯塔省急诊科常见的就诊问题，需要进一步研究这些趋势以了解与就诊差异相关的因素。重要发现包括在研究期间就诊率总体下降、基于年龄、性别和社会经济/文化地位的差异以及早期随访率低。可以实施有针对性的干预措施来针对特定群体，减少到艾伯塔省急诊科与哮喘相关的就诊。
