School of Public Health and Health Services, Department of Emergency Medicine, George Washington University, 2121 K Street NW, Washington, DC 20037, USA.
Ann Emerg Med. 2010 Sep;56(3):253-7. doi: 10.1016/j.annemergmed.2010.01.031. Epub 2010 Feb 26.
We assess hospital readmission and death within 60 days in older adults admitted from the emergency department (ED) and discharged by an inpatient service within 24 hours.
This was a retrospective review of ED patients aged 64 years or older, admitted from 2 hospitals (2004 to 2006), who were discharged home within 24 hours. Excluded were in-hospital deaths, observation admissions, transfers to other facilities, patients who left against medical advice, and hospice patients. Outcomes were 72-hour and 30-day readmissions and postdischarge deaths that occurred within 60 days of ED admission. Logistic regression was used to assess for predictors of readmission. A chart review of deaths after discharge was performed to assess for potential contributors to adverse outcomes.
A total of 1,470 admissions met inclusion criteria as 1-day admissions. Of those, 22 (1.5%) patients returned for hospital readmission within 72 hours and 156 (10.6%) within 30 days of discharge. In the multivariable analysis, previous admissions (odds ratio [OR] 1.3; 95% confidence interval [CI] 1.1 to 1.4) and an admission diagnosis of heart failure (OR 2.2; 95% CI 1.0 to 5.0) were associated with 30-day readmission. In 841 individual patients with greater than or equal to one 1-day admission, there were 15 deaths (1.8%) within 60 days. Of those, 11 (73%) patients had abnormal ED ECG results, 6 (40%) were ruled out for acute myocardial infarction while hospitalized, and 3 (20%) had definitive follow-up arranged at discharge.
One-day admissions in hospitalized older adults through the ED do not represent a group at low risk for postdischarge adverse outcomes.
我们评估了在急诊部门（ED）入院并在 24 小时内由住院服务出院的老年人在 60 天内的再次入院和死亡情况。
这是一项对 2 家医院（2004 年至 2006 年）年龄在 64 岁或以上的 ED 患者的回顾性研究，这些患者在 24 小时内出院回家。排除院内死亡、观察入院、转至其他医疗机构、患者未经医嘱出院和临终关怀患者。结局是 ED 入院后 72 小时和 30 天的再入院率和 60 天内的出院后死亡率。使用逻辑回归评估再入院的预测因素。对出院后死亡的病例进行了图表回顾，以评估不良结局的潜在原因。
共有 1470 例入院符合 1 天入院标准。其中，22 例（1.5%）患者在 72 小时内再次因医院入院，156 例（10.6%）患者在出院后 30 天内再次入院。多变量分析显示，既往入院（优势比 [OR] 1.3；95%置信区间 [CI] 1.1 至 1.4）和入院诊断为心力衰竭（OR 2.2；95% CI 1.0 至 5.0）与 30 天再入院相关。在 841 名有 1 次或以上 1 天入院的患者中，有 15 例（1.8%）在 60 天内死亡。其中，11 例（73%）患者的 ED 心电图结果异常，6 例（40%）在住院期间排除急性心肌梗死，3 例（20%）在出院时安排了明确的随访。
通过 ED 住院的老年患者 1 天入院并不代表出院后不良结局风险低的患者群体。
