Jelinek George A, Ingarfield Sharyn L, Mountain David, Gibson Nicholas P, Jacobs Ian G
Discipline of Emergency Medicine, University of Western Australia, Western Australia, Australia.
Emerg Med Australas. 2009 Aug;21(4):269-76. doi: 10.1111/j.1742-6723.2009.01196.x.
We characterized patients admitted via ED with a principal hospital discharge diagnosis of pulmonary embolism (PE) and compared mortality of those diagnosed in the ED with those diagnosed after admission.
Patients with a hospital discharge diagnosis ICD 10 I26 presenting to the ED in Perth, Western Australia between 1 July 2000 and 30 December 2006 had records from the Emergency Department Information System linked to the Western Australian Hospital Morbidity Data System and the death registry.
Of 2250 patients (mean age 60.4), 1227 (54.5%) were female. Of 1931 patients with an ED diagnosis recorded, 1207 (62.5%) were diagnosed with PE in ED. Of these, 383 (17.0%) had presented to an ED within 28 days previously, 142 (37.1%) with either chest pain or breathing problems, with 207 (54.0%) admitted but not receiving a principal hospital discharge diagnosis of PE. There were 127 (5.6%) in-hospital deaths. Controlling for age and comorbidity with logistic regression, patients diagnosed with PE in ED were less likely to die in hospital, within 7 and 30 days of ED arrival, than those diagnosed after admission (adjusted OR 0.31, 95% CI 0.20-0.47; adjusted OR 0.32, 95% CI 0.19-0.53; adjusted OR 0.30, 95% CI 0.20-0.44; respectively).
Making the diagnosis of PE in ED was associated with a substantial survival advantage that persisted after hospital discharge.
我们对因主要出院诊断为肺栓塞（PE）而通过急诊科入院的患者进行了特征分析，并比较了在急诊科确诊的患者与入院后确诊的患者的死亡率。
2000年7月1日至2006年12月31日期间在西澳大利亚州珀斯的急诊科就诊且出院诊断为国际疾病分类第10版（ICD 10）I26的患者，其急诊部信息系统记录与西澳大利亚州医院发病率数据系统及死亡登记处相关联。
在2250例患者（平均年龄60.4岁）中，1227例（54.5%）为女性。在有急诊诊断记录的1931例患者中，1207例（62.5%）在急诊科被诊断为PE。其中，383例（17.0%）在之前28天内曾到急诊科就诊，142例（37.1%）有胸痛或呼吸问题，207例（54.0%）入院但未获得主要出院诊断为PE。有127例（5.6%）住院死亡。通过逻辑回归控制年龄和合并症后，在急诊科被诊断为PE的患者在住院期间、到达急诊科后7天和30天内死亡的可能性低于入院后确诊的患者（调整后的比值比分别为0.31，95%可信区间0.20 - 0.47；调整后的比值比为0.32，95%可信区间0.19 - 0.53；调整后的比值比为0.30，95%可信区间0.20 - 0.44）。
在急诊科诊断PE与出院后仍持续存在的显著生存优势相关。
