Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
Am J Surg. 2011 Jul;202(1):1-7. doi: 10.1016/j.amjsurg.2010.05.003. Epub 2011 May 31.
Our objective was to determine factors associated with delays to first treatment for emergency department (ED) patients diagnosed with small-bowel obstruction (SBO).
This was a retrospective study of ED patients with SBO. Data were collected from medical records, administrative databases, and staffing schedules at an urban, tertiary care medical center from June 1, 2001, to November 30, 2002. Patient-related characteristics and processes of ED and hospital care were evaluated. Outcomes studied were time to first treatment (nasogastric tube or surgery) and risk of surgical resection.
A total of 193 patients were diagnosed with confirmed intestinal obstruction. Patients with longer times to first treatment arrived during ED clinician hand-offs (adjusted hazard ratio, .40; 95% confidence interval, .17-.98). Patients with longer times to surgery consult (ref. first quartile) had greater odds of surgical resection (second quartile adjusted odds ratio, 6.91; 95% confidence interval, 1.85-24.80).
Remediable ED and hospital factors were associated with longer times to treatment for patients with bowel obstruction.
我们的目的是确定与急诊（ED）患者小肠梗阻（SBO）首次治疗延迟相关的因素。
这是一项对 ED 伴有 SBO 的患者进行的回顾性研究。数据来自 2001 年 6 月 1 日至 2002 年 11 月 30 日，一个城市三级护理医疗中心的病历、行政数据库和人员配备表。评估了患者相关特征和 ED 及医院治疗过程。研究的结果是首次治疗（鼻胃管或手术）时间和手术切除风险。
共有 193 名患者被诊断为确诊的肠梗阻。首次治疗时间较长的患者在 ED 临床医生交接时到达（调整后的危险比，0.40；95%置信区间，0.17-0.98）。手术咨询时间较长的患者（参考第一四分位数）手术切除的可能性更大（第二四分位数调整后的比值比，6.91；95%置信区间，1.85-24.80）。
可纠正的 ED 和医院因素与肠梗阻患者的治疗时间延长有关。
