Nelson Kyle A, Boslaugh Sarah E, Hodge Dee
Division of Emergency Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA.
Pediatr Emerg Care. 2009 Dec;25(12):835-40. doi: 10.1097/PEC.0b013e3181c330c4.
Over time, we observed more visits in our pediatric emergency department with length-of-stay (LOS) of more than 10 hours, whereas our mean LOS was approximately 3 hours. We sought to characterize factors associated with this extremely long LOS.
Eighty-one visits with LOS more than 10 hours were identified from January 1, 2001, to June 30, 2003. In this retrospective study, we compared these cases with 405 randomly selected age-matched controls with LOS less than 10 hours (5 controls per case).
The groups were similar for sex, visit month, arrival mode, and level of training of the supervising physician. Cases more frequently arrived during night shifts (30% vs 13%) and had laboratory tests (93% vs 32%), radiological studies (83% vs 34%), procedures (28% vs 15%), sedations (24% vs 4%), subspecialty consultations (84% vs 20%), chief complaints of abdominal pain (42% vs 6%) and diagnoses of appendicitis (10% vs 1%), and had a greater hospitalization rate (67 vs 19%). Although more cases involved white patients (57% vs 31%), race was not associated with LOS more than 10 hours in adjusted analysis. In multivariable analysis, longer waiting time (odds ratio [OR], 1.013; 95% confidence interval [CI], 1.007-1.019), night shift arrival (OR, 5.0; 95% CI, 1.9-12.8), higher triage acuity (lowest acuity: OR, 0.003; 95% CI, 0.0-0.286), radiology study other than radiographs (OR, 18.0; 95% CI, 7.5-43.1), and subspecialty consultation (OR, 7.6; 95% CI, 3.2-18.3) were associated with LOS more than 10 hours.
In our pediatric emergency department, risk factors for LOS more than 10 hours included longer waiting time, night shift arrivals, high triage acuity, radiology studies, and subspecialty consultations. These factors may also be important considerations for quality improvement initiatives at other institutions.
随着时间的推移，我们发现儿科急诊科中住院时间（LOS）超过10小时的就诊病例增多，而我们的平均住院时间约为3小时。我们试图确定与这种极长住院时间相关的因素。
从2001年1月1日至2003年6月30日，共识别出81例住院时间超过10小时的就诊病例。在这项回顾性研究中，我们将这些病例与405例随机选择的年龄匹配的对照病例进行比较，这些对照病例的住院时间少于10小时（每例病例对应5例对照）。
两组在性别、就诊月份、到达方式以及主治医生的培训水平方面相似。病例组更常在夜班期间到达（30%对13%），且进行实验室检查（93%对32%）、放射学检查（83%对34%）、操作（28%对15%）、镇静（24%对4%）、专科会诊（84%对20%），腹痛为主诉（42%对6%）以及阑尾炎诊断（10%对1%）的比例更高，住院率也更高（67对19）。尽管病例组中白人患者更多（57%对31%），但在调整分析中，种族与住院时间超过10小时无关。在多变量分析中，等待时间更长（优势比[OR]，1.013；95%置信区间[CI]，1.007 - 1.019）、夜班到达（OR，5.0；95% CI，1.9 - 12.8）、分诊 acuity 更高（最低 acuity：OR，0.003；95% CI，0.0 - 0.286）、除X光片外的放射学检查（OR，18.0；95% CI，7.5 - 43.1）以及专科会诊（OR，7.6；95% CI，3.2 - 18.3）与住院时间超过10小时相关。
在我们的儿科急诊科，住院时间超过10小时的危险因素包括等待时间更长、夜班到达、分诊 acuity 高、放射学检查以及专科会诊。这些因素也可能是其他机构质量改进举措的重要考虑因素。
