From the Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Acad Emerg Med. 2009 Oct;16(10):949-55. doi: 10.1111/j.1553-2712.2009.00515.x.
The objective was to estimate the national left-without-being-seen (LWBS) rate and to identify patient, visit, and institutional characteristics that predict LWBS.
This was a retrospective cross-sectional analysis using the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 1998 to 2006. Bivariate and multivariate analyses were performed to identify predictors of LWBS.
The national LWBS rate was 1.7 (95% confidence interval [CI] = 1.6 to 1.9) patients per 100 emergency department (ED) visits each year. In multivariate analysis, patients at extremes of age (<18 years, odds ratio [OR] = 0.80, 95% CI = 0.66 to 0.96; and > or =65 years, OR = 0.46, 95% CI = 0.32 to 0.64) and nursing home residents (OR = 0.29, 95% CI = 0.08 to 1.00) were associated with lower LWBS rates. Nonwhites (black or African American (OR = 1.41, 95% CI = 1.22 to 1.63) and Hispanic (OR = 1.25, 95% CI = 1.04 to 1.49), Medicaid (OR = 1.47, 95% CI = 1.27 to 1.70), self-pay (OR = 1.96, 95% CI = 1.65 to 2.32), or other insurance (OR = 2.09, 95% CI = 1.74 to 2.52) patients were more likely to LWBS. Visit characteristics associated with LWBS included visits for musculoskeletal (OR = 0.70, 95% CI = 0.57 to 0.85), injury/poisoning/adverse event (OR = 0.65, 95% CI = 0.53 to 0.80), and miscellaneous (OR = 1.56, 95% CI = 1.19 to 2.05) complaints. Visits with low triage acuity were more likely to LWBS (OR = 3.59, 95% CI = 2.81 to 4.58), whereas visits that were work-related were less likely to LWBS (OR = 0.19, 95% CI = 0.12 to 0.29). Institutional characteristics associated with LWBS were visits in metropolitan areas (OR = 2.11, 95% CI = 1.66 to 2.70) and teaching institutions (OR = 1.33, 95% CI = 1.06 to 1.67).
Several patient, visit, and hospital characteristics are independently associated with LWBS. Prediction and benchmarking of LWBS rates should adjust for these factors.
本研究旨在评估全国范围内未被诊治（LWBS）率，并确定预测 LWBS 的患者、就诊和医疗机构特征。
本研究采用 1998 年至 2006 年全国医院门诊医疗调查（NHAMCS）进行回顾性横断面分析。采用双变量和多变量分析来确定 LWBS 的预测因素。
全国范围内，每年每 100 次急诊就诊中 LWBS 的发生率为 1.7 例（95%置信区间 [CI] = 1.6 至 1.9）。多变量分析显示，年龄处于极值的患者（<18 岁，比值比 [OR] = 0.80，95%CI = 0.66 至 0.96；≥65 岁，OR = 0.46，95%CI = 0.32 至 0.64）和疗养院居民（OR = 0.29，95%CI = 0.08 至 1.00）的 LWBS 发生率较低。非白种人（黑种人或非裔美国人（OR = 1.41，95%CI = 1.22 至 1.63）和西班牙裔（OR = 1.25，95%CI = 1.04 至 1.49）、医疗补助（OR = 1.47，95%CI = 1.27 至 1.70）、自付（OR = 1.96，95%CI = 1.65 至 2.32）或其他保险（OR = 2.09，95%CI = 1.74 至 2.52）的患者更有可能 LWBS。与 LWBS 相关的就诊特征包括肌肉骨骼（OR = 0.70，95%CI = 0.57 至 0.85）、损伤/中毒/不良事件（OR = 0.65，95%CI = 0.53 至 0.80）和其他（OR = 1.56，95%CI = 1.19 至 2.05）投诉。分诊 acuity 较低的就诊更有可能发生 LWBS（OR = 3.59，95%CI = 2.81 至 4.58），而与工作相关的就诊则不太可能发生 LWBS（OR = 0.19，95%CI = 0.12 至 0.29）。与 LWBS 相关的医疗机构特征包括在大都市区（OR = 2.11，95%CI = 1.66 至 2.70）和教学机构（OR = 1.33，95%CI = 1.06 至 1.67）就诊。
多个患者、就诊和医院特征与 LWBS 独立相关。LWBS 率的预测和基准测试应考虑这些因素。
