Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Crit Care Med. 2010 Nov;38(11):2161-8. doi: 10.1097/CCM.0b013e3181f3e09c.
Emergency department resuscitation plays a significant role in sepsis care, and it is unknown if patient outcomes vary by institution based on the level of sepsis experience of the emergency department. This study examines whether there is an association between the annual volume of patients admitted via the emergency department with sepsis and inpatient mortality.
Cross-sectional analysis of the 2007 Nationwide Inpatient Sample.
We included 87,166 adult emergency department sepsis admissions from 551 hospitals.
Hospitals were categorized into quartiles by 2007 emergency department sepsis volume. Univariate associations of patient characteristics, hospital characteristics, and inpatient mortality with sepsis volume level were evaluated by chi-square test. A population-averaged logistic regression model of inpatient mortality was used to estimate the effects of age, gender, comorbid conditions, payer status, median zip code income, hospital bed size, teaching status, and emergency department sepsis volume.
Overall inpatient sepsis mortality was 18.0% and early mortality (2 days after admission) was 6.9%. The risk-adjusted odds ratios of mortality were 0.73 (95% confidence interval, 0.64-0.83; p < .001) in quartile 4 (highest volume), 0.83 in quartile 3 (95% confidence interval, 0.74-0.93; p = .001), and 0.90 in quartile 2 (95% confidence interval, 0.82-0.99; p < .05) when compared to quartile 1 (lowest volume). Adjusted results were similar for early mortality: 0.69 (95% confidence interval, 0.61-0.76; p < .001) in quartile 4, 0.83 in quartile 3 (95% confidence interval, 0.74-0.93; p < .05), and 0.85 in quartile 2 (95% confidence interval, 0.77-0.94; p < .05) when compared to quartile 1.
After adjustment for comorbidity and hospital-level factors, there was a significant relationship between emergency department sepsis case volume and overall and early inpatient mortality among patients admitted through the emergency department with sepsis. Patients admitted to hospitals in the highest-volume quartile had 27% lower odds of inpatient mortality in this large heterogeneous sample.
急诊科复苏在脓毒症治疗中起着重要作用，但尚不清楚患者结局是否因急诊科脓毒症经验水平的不同而有所差异。本研究旨在探讨通过急诊科收治的脓毒症患者人数与住院死亡率之间是否存在关联。
2007 年全国住院患者样本的横断面分析。
纳入了 551 家医院的 87166 例成人急诊科脓毒症患者。
根据 2007 年急诊科脓毒症患者人数将医院分为四分位数。通过卡方检验评估患者特征、医院特征和住院死亡率与脓毒症患者人数水平的单变量相关性。采用群体平均逻辑回归模型估计年龄、性别、合并症、支付方式、邮政编码中位数收入、医院床位数、教学状态和急诊科脓毒症患者人数对住院死亡率的影响。
总体脓毒症住院死亡率为 18.0%，早期死亡率（入院后 2 天）为 6.9%。风险调整后死亡率的比值比为 quartile 4（最高量）0.73（95%置信区间，0.64-0.83；p <.001），quartile 3（0.83，95%置信区间，0.74-0.93；p =.001）和 quartile 2（0.90，95%置信区间，0.82-0.99；p <.05）与 quartile 1（最低量）相比。早期死亡率的调整结果相似：quartile 4 为 0.69（95%置信区间，0.61-0.76；p <.001），quartile 3 为 0.83（95%置信区间，0.74-0.93；p <.05），quartile 2 为 0.85（95%置信区间，0.77-0.94；p <.05）与 quartile 1 相比。
在调整合并症和医院水平因素后，急诊科脓毒症患者人数与通过急诊科住院的脓毒症患者的总死亡率和早期死亡率之间存在显著关系。在这个大型异质样本中，入住最高量 quartile 医院的患者住院死亡率降低了 27%。
Zotero 插件