Department of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, Loma Linda, CA, USA.
Ann Emerg Med. 2012 Aug;60(2):147-51. doi: 10.1016/j.annemergmed.2012.02.024. Epub 2012 Apr 14.
A previous single-region study has suggested that acuity varies by patient age in ways that may affect subspecialty critical care skills retention. This study seeks to independently confirm or refute these findings by using the National Hospital Ambulatory Medical Care Survey (NHAMCS), a large nationally representative database of emergency department (ED) visits.
Using 8 years of NHAMCS data composed of 288,199 ED visits, the following 6 measures of patient acuity were weighted and graphically stratified by patient age: triage category, hospital admission, critical care unit admission, death in the ED, cardiopulmonary resuscitation, and tracheal intubation. Their relative frequency was then compared between adults and children (<18 years).
All measures of acuity increased with age and were higher in adults versus children: highest triage category odds ratio 1.3, hospital admission odds ratio 4.2, critical care unit admission odds ratio 4.5, death in the ED odds ratio 5.8, cardiopulmonary resuscitation odds ratio 4.7, and tracheal intubation odds ratio 2.5.
This analysis of a large, nationally representative ED sample found substantial age-based differences in patient acuity that can inform discussion about subspecialty critical care skills retention.
之前的单区域研究表明，视力会因患者年龄的不同而有所差异，这可能会影响到亚专科重症监护技能的保留。本研究试图通过使用全国医院门诊医疗调查（NHAMCS），这一大型全国代表性的急诊就诊数据库，独立确认或反驳这些发现。
利用 NHAMCS 8 年的数据，其中包含 288199 例急诊就诊，对以下 6 项患者病情严重程度的指标进行加权，并根据患者年龄进行图形分层：分诊类别、住院、重症监护病房入院、急诊死亡、心肺复苏和气管插管。然后比较成人和儿童（<18 岁）之间这些指标的相对频率。
所有严重程度的指标都随年龄增长而增加，且成人高于儿童：最高分诊类别比值比为 1.3，住院比值比为 4.2，重症监护病房入院比值比为 4.5，急诊死亡比值比为 5.8，心肺复苏比值比为 4.7，气管插管比值比为 2.5。
本分析对一个大型的、全国代表性的急诊样本进行了分析，发现患者病情严重程度存在显著的年龄差异，这可以为讨论亚专科重症监护技能保留提供信息。
