Moore Gaye, Hepworth Graham, Weiland Tracey, Manias Elizabeth, Gerdtz Marie Frances, Kelaher Margaret, Dunt David
Melbourne School of Population Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Level 4, 207 Bouverie St, Carlton, Victoria 3010, Australia.
Australas Emerg Nurs J. 2012 Feb;15(1):2-13. doi: 10.1016/j.aenj.2011.12.004. Epub 2012 Jan 31.
To prospectively evaluate the accuracy of a predictive model to identify homeless people at risk of representation to an emergency department.
A prospective cohort analysis utilised one month of data from a Principal Referral Hospital in Melbourne, Australia. All visits involving people classified as homeless were included, excluding those who died. Homelessness was defined as living on the streets, in crisis accommodation, in boarding houses or residing in unstable housing. Rates of re-presentation, defined as the total number of visits to the same emergency department within 28 days of discharge from hospital, were measured. Performance of the risk screening tool was assessed by calculating sensitivity, specificity, positive and negative predictive values and likelihood ratios.
Over the study period (April 1, 2009 to April 30, 2009), 3298 presentations from 2888 individuals were recorded. The homeless population accounted for 10% (n=327) of all visits and 7% (n=211) of all patients. A total of 90 (43%) homeless people re-presented to the emergency department. The predictive model included nine variables and achieved 98% (CI, 0.92-0.99) sensitivity and 66% (CI, 0.57-0.74) specificity. The positive predictive value was 68% and the negative predictive value was 98%. The positive likelihood ratio 2.9 (CI, 2.2-3.7) and the negative likelihood ratio was 0.03 (CI, 0.01-0.13).
The high emergency department re-presentation rate for people who were homeless identifies unresolved psychosocial health needs. The emergency department remains a vital access point for homeless people, particularly after hours. The risk screening tool is key to identify medical and social aspects of a homeless patient's presentation to assist early identification and referral.
前瞻性评估一种预测模型识别有急诊科复诊风险的无家可归者的准确性。
一项前瞻性队列分析利用了澳大利亚墨尔本一家主要转诊医院一个月的数据。纳入所有涉及被归类为无家可归者的就诊病例，排除死亡者。无家可归被定义为露宿街头、住在危机收容所、寄宿公寓或居住在不稳定住房中。测量复诊率，即出院后28天内到同一急诊科就诊的总次数。通过计算敏感性、特异性、阳性和阴性预测值以及似然比来评估风险筛查工具的性能。
在研究期间（2009年4月1日至2009年4月30日），记录了来自2888名个体的3298次就诊。无家可归者占所有就诊病例的10%（n = 327），占所有患者的7%（n = 211）。共有90名（43%）无家可归者再次到急诊科就诊。预测模型包含9个变量，敏感性达到98%（CI，0.92 - 0.99），特异性为66%（CI，0.57 - 0.74）。阳性预测值为68%，阴性预测值为98%。阳性似然比为2.9（CI，2.2 - 3.7），阴性似然比为0.03（CI，0.01 - 0.13）。
无家可归者的急诊科复诊率高表明存在未解决的心理社会健康需求。急诊科仍然是无家可归者的重要就医途径，尤其是在非工作时间。风险筛查工具是识别无家可归患者就诊的医疗和社会方面以协助早期识别和转诊的关键。
