Department of Emergency Medicine, Department of Epidemiology and Community Medicine, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON.
CJEM. 2012 Mar;14(2):83-9. doi: 10.2310/8000.2012.110552.
ABSTRACTObjective:There are currently no widely used guidelines to determine which older patients with acute respiratory conditions require hospital admission. This study assessed the need for clinical decision rules to help determine whether hospital admission is required for patients over 50 years for three common respiratory conditions: chronic obstructive pulmonary disease (COPD), heart failure (HF), and community-acquired pneumonia (CAP).
Postal survey.
Emergency physicians (EPs) from the United States, Canada, and Australasia.
A random sample of EPs from the United States, Canada, and Australasia.
A modified Dillman technique with a prenotification letter and up to three postal surveys.
EP opinions regarding the need for and willingness to use clinical decision rules for emergency department (ED) patients over 50 years with COPD, HF, or CAP to predict hospital admission. We assessed the required sensitivity of each rule for return ED visit or death within 14 days.
A total of 801 responses from 1,493 surveys were received, with response rates of 55%, 60%, and 46% for Australasia, Canada, and the United States, respectively. Over 90% of EPs reported that they would consider using clinical decision rules for HF, CAP, and COPD. The median required sensitivity for death within 14 days was 97 to 98% for all conditions.
EPs are likely to adopt highly sensitive clinical decision rules to predict the need for hospital admission for patients over 50 years with COPD, HF, or CAP.
目前尚无广泛使用的指南来确定哪些患有急性呼吸系统疾病的老年患者需要住院治疗。本研究评估了临床决策规则的需求，以帮助确定对于 COPD、心力衰竭 (HF) 和社区获得性肺炎 (CAP) 这三种常见呼吸系统疾病，是否需要对 50 岁以上的患者进行住院治疗。
邮寄调查。
来自美国、加拿大和澳大拉西亚的急诊医生 (EP)。
来自美国、加拿大和澳大拉西亚的 EP 随机样本。
使用经改良的 Dillman 技术，先发送预先通知信，然后再发送三封邮件。
EP 对是否需要以及是否愿意使用针对 50 岁以上患有 COPD、HF 或 CAP 的急诊科患者的临床决策规则来预测住院治疗的意见。我们评估了每种规则对 14 天内返回急诊科就诊或死亡的预测所需的敏感性。
共收到 1493 份调查问卷中的 801 份回复，澳大利亚、加拿大和美国的回复率分别为 55%、60%和 46%。超过 90%的 EP 报告称，他们可能会考虑使用临床决策规则来治疗 HF、CAP 和 COPD。所有情况下，预测 14 天内死亡所需的敏感性中位数均为 97%至 98%。
EP 可能会采用高度敏感的临床决策规则来预测是否需要对 50 岁以上患有 COPD、HF 或 CAP 的患者进行住院治疗。
