在 ICU 入院前，ED 住院时间与患者死亡率有关吗？

Is ED length of stay before ICU admission related to patient mortality?

机构信息

Department of Intensive Care, The Alfred Hospital, Prahran, Australia.

出版信息

Emerg Med Australas. 2010 Apr;22(2):145-50. doi: 10.1111/j.1742-6723.2010.01272.x.

DOI:10.1111/j.1742-6723.2010.01272.x

PMID:20534049

Abstract

OBJECTIVE

To describe and identify the relationship between ED length of stay (LOS) and mortality after ICU admission.

METHODS

We undertook a retrospective cohort study of records from the Australian and New Zealand Intensive Care Society Adult Patient Database (from 1 January 2000 to 31 December 2006). Data from 45 hospitals and 48 803 ED patients directly transferred to ICU were included. Patients were divided into ED LOS<8 h and ED LOS>or=8 h. Univariate and multivariate analyses were performed.

RESULTS

Median ED LOS was 3.9 h (interquartile range 2.0-6.8). Patients transferred within 8 h (80.9%) were younger (P<0.001) and more seriously ill (higher mortality and mechanical ventilation rate) than those transferred>or=8 h. There was no clear relationship between ED LOS and hospital survival for patients admitted directly to ICU (odds ratio=1.01 per hour, 95% confidence intervals 0.99-1.02).

CONCLUSION

Although 20% of critically ill patients spend more than 8 h in ED before transfer to ICU, we were unable to demonstrate an adverse relationship between time in ED and hospital mortality.

摘要

目的

描述并确定 ICU 入院后 ED 住院时间（LOS）与死亡率之间的关系。

方法

我们对澳大利亚和新西兰重症监护学会成人患者数据库（2000 年 1 月 1 日至 2006 年 12 月 31 日）的记录进行了回顾性队列研究。纳入了来自 45 家医院的 48803 例直接转入 ICU 的 ED 患者的数据。患者分为 ED LOS<8 h 和 ED LOS>or=8 h。进行了单变量和多变量分析。

结果

ED LOS 的中位数为 3.9 h（四分位间距 2.0-6.8）。8 h 内转科的患者（80.9%）比>or=8 h 转科的患者年龄更小（P<0.001），病情更重（死亡率和机械通气率更高）。对于直接收入 ICU 的患者，ED LOS 与医院生存率之间没有明显关系（每小时的优势比为 1.01，95%置信区间 0.99-1.02）。