Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, MA 02115, USA.
J Periodontol. 2011 Jun;82(6):809-19. doi: 10.1902/jop.2010.100228. Epub 2010 Dec 7.
The chances of presenting to hospital emergency departments (EDs) are significantly higher in individuals who ignore regular dental care and in those with medical conditions. Little is known about nationwide estimates of hospital-based ED visits caused by periodontal conditions in the United States. The objective of this study is to determine the incidence of ED visits caused by periodontal conditions that occurred in a 2006 nationwide sample and to identify the risk factors for hospitalization during the ED visits.
The Nationwide Emergency Department Sample (NEDS) for 2006 was used for this study. Patients who visited the ED with a primary diagnosis of acute gingivitis, chronic gingivitis, gingival recession, aggressive or acute periodontitis, chronic periodontitis, periodontosis, accretions, other specified periodontal disease, or unspecified gingival and periodontal disease were selected for this study. Estimates were projected to the national levels using the discharge weights. The association between patient characteristics and the odds of being hospitalized was examined using a multivariable logistic regression analysis.
A total of 85,039 visits to hospital-based EDs with a mean charge per visit of $456.31 and total charges close to $33.3 million were primarily attributed to gingival and periodontal conditions in the United States. Close to 36% and 33% of all visits occurred among the lowest income group and uninsured population, respectively. The total ED charges for those covered by Medicare, Medicaid, private insurance, and other insurance plans were close to $4.95 million, $9.14 million, $8.01 million, and $0.92 million, respectively. The uninsured were charged a total of $10.06 million. Inpatient admission to the same hospital was required for 1,167 visits. The total hospitalization charge for this group was $17.51 million. Patients with comorbid conditions (congestive heart failure, valvular disease, hypertension, paralysis, neurologic disorders, chronic pulmonary disease, hypothyroidism, liver disease, AIDS, coagulopathy, deficiency anemia, obesity, alcohol abuse, or drug abuse) were associated with higher odds for hospitalization during an ED visit for periodontal conditions compared to those without comorbid conditions (P <0.05). Patients who had a primary diagnosis of acute or aggressive periodontitis were associated with significantly higher odds of being hospitalized during ED visits.
Estimates from the NEDS suggest that a total of 85,039 hospital-based ED visits had a primary diagnosis for periodontal conditions. Close to $33.3 million was charged by hospitals for treating these conditions on an emergency basis. ED visits with a primary diagnosis for acute and aggressive periodontitis, covered by Medicare insurance, and comorbid conditions were more likely to result in hospitalization based on the analysis of the NEDS. However, when interpreting these conclusions, one should keep the limitations inherent to hospital discharge datasets in perspective.
忽略定期口腔护理和患有某些疾病的个体，到医院急诊部（ED）就诊的几率明显更高。在美国，人们对牙周病导致的全国范围内基于医院的 ED 就诊的估计知之甚少。本研究的目的是确定 2006 年全国范围内牙周病导致的 ED 就诊的发生率，并确定 ED 就诊期间住院的风险因素。
本研究使用了 2006 年的全国急诊部样本（NEDS）。选择因急性牙龈炎、慢性牙龈炎、牙龈退缩、侵袭性或急性牙周炎、慢性牙周炎、牙周病、附着体、其他特定牙周病或未特指的牙龈和牙周病而到 ED 就诊的患者作为研究对象。使用出院权重将估计值推算到全国水平。使用多变量逻辑回归分析检查患者特征与住院几率之间的关联。
在美国，共有 85039 次以牙龈和牙周病为主要诊断的医院 ED 就诊，每次就诊的平均费用为 456.31 美元，总费用接近 3330 万美元。收入最低的群体和未参保人群分别占所有就诊的近 36%和 33%。医疗保险、医疗补助、私人保险和其他保险计划覆盖的患者的总 ED 费用分别接近 4950 万美元、9140 万美元、8010 万美元和 920 万美元。未参保者的总费用为 1.006 亿美元。有 1167 名患者需要住院治疗。这组患者的总住院费用为 1.751 亿美元。患有合并症（充血性心力衰竭、瓣膜病、高血压、瘫痪、神经障碍、慢性肺病、甲状腺功能减退、肝病、艾滋病、凝血障碍、贫血、肥胖、酗酒或药物滥用）的患者与没有合并症的患者相比，在因牙周病就诊时住院的几率更高（P<0.05）。患有急性或侵袭性牙周炎主要诊断的患者在 ED 就诊时住院的几率显著更高。
来自 NEDS 的估计表明，共有 85039 次基于医院的 ED 就诊的主要诊断为牙周病。医院对这些急症的治疗费用总计近 3330 万美元。根据 NEDS 的分析，以急性和侵袭性牙周炎为主要诊断、由医疗保险承保以及合并症的 ED 就诊更有可能导致住院。然而，在解释这些结论时，应考虑到医院出院数据集固有的局限性。
