Clinic of Internal Medicine, Uster Hospital, Switzerland.
Swiss Med Wkly. 2012 Feb 10;142:w13510. doi: 10.4414/smw.2012.13510. eCollection 2012.
Community acquired pneumonia (CAP) and sepsis are leading causes of hospitalisation after admission to a medical emergency department (ED). Identifying these potentially life-threatening diseases is not always easy due to often unspecific or minimal symptoms. However, quick application of antibiotics is known to be crucial and is correlated with better outcome. The international guidelines of the joint commission suggest a 4 hour-rule for optimal quality of care in CAP and sepsis. In this study we assessed the door-to-needle time (DNT) in patients admitted to our ED with the diagnosis of CAP and/or sepsis. Furthermore we investigated the CRB-65 score, its clinical performance and its influence on DNT.
Retrospective observational study of all patients admitted and hospitalised through the ED of a Swiss hospital with the diagnosis of sepsis or pneumonia from June 2009 to June 2010 (n = 139).
In 73% of the cases DNT was lower than the recommended 4 hours. In CAP, a correlation between the CRB-65 and DNT was not found (ρ = 0.13, p = 0.30). Further parameters, e.g. temperature or blood pressure did not improve DNT significantly. Analysis of the CRB-65 score was regularly impeded due to absent documented information on respiratory rate or confusion state.
In most cases it was feasible to fulfill the 4 hours DNT. The CRB-65 score is an easy bedside tool, which was not routinely assessed by our emergency room personnel but its assessment did not affect DNT in our hospital.
社区获得性肺炎 (CAP) 和败血症是患者入住急诊医学部 (ED) 后住院的主要原因。由于通常存在非特异性或最小的症状，因此识别这些潜在的危及生命的疾病并不总是容易的。然而，快速应用抗生素是至关重要的，并且与更好的结果相关。联合委员会的国际指南建议 CAP 和败血症的最佳护理质量为 4 小时规则。在这项研究中，我们评估了以 CAP 和/或败血症诊断收入我们 ED 的患者的门到针时间 (DNT)。此外，我们还研究了 CRB-65 评分、其临床性能及其对 DNT 的影响。
对 2009 年 6 月至 2010 年 6 月瑞士一家医院通过 ED 收治的所有诊断为败血症或肺炎的患者进行回顾性观察性研究 (n = 139)。
在 73%的情况下，DNT 低于推荐的 4 小时。在 CAP 中，CRB-65 与 DNT 之间没有相关性 (ρ = 0.13，p = 0.30)。进一步的参数，例如体温或血压并没有显著改善 DNT。由于未记录呼吸频率或意识状态的信息，因此经常无法对 CRB-65 评分进行分析。
在大多数情况下，满足 4 小时 DNT 是可行的。CRB-65 评分是一种简单的床边工具，我们的急诊室人员并未常规评估，但在我们的医院，其评估并未影响 DNT。
