Department of Mathematics, University of Iceland, Reykjavik, Iceland.
Emerg Med J. 2013 Aug;30(8):662-8. doi: 10.1136/emermed-2012-201129. Epub 2012 Sep 14.
The needs of patients with uncompleted visits to the emergency department (ED) are uncertain. The aim was to evaluate ED patients who leave against medical advice (AMA) and who leave without being seen (WBS) regarding repeat ED visits, hospitalisation and mortality within 30 days.
The National University Hospital operates the only ED for adults in the capital area of Reykjavik. The source of data was the electronic records for patients 18 years or older, who left AMA, who left WBS, who had the ICD-10 code Z53.2, or who completed their visits. ED visits, hospital admissions and the death registry are filed with the personal identification number, which enabled recognition of the index visit, and the outcomes, rates of return visits, hospitalisation and death.
Of 107 119 patients, 77 left AMA, 4471 left WBS and 423 had code Z53.2. The HR for returning to the ED within 30 days was 4.79 for AMA patients, 4.84 for WBS patients and 3.67 for Z53.2 patients. The HR for hospitalisation within 30 days was 6.90 for AMA patients, 1.09 for WBS patients and 1.07 for Z53.2 patients. The HR for death within 30 days was 10.97 for AMA patients, 0.84 for WBS and no deaths occurred among Z53.2 patients.
During 30 days follow-up, AMA and WBS patients had an increased rate of repeat ED visits compared with those patients who completed their ED visits. AMA patients also had an increased rate of hospitalisations.
急诊（ED）未完成就诊患者的需求不确定。本研究旨在评估因拒绝医疗建议（AMA）和未得到诊治（WBS）而离开 ED 的患者，以及在 30 天内重复 ED 就诊、住院和死亡的情况。
国立大学医院是雷克雅未克首都地区唯一的成人 ED。数据来源于年龄在 18 岁及以上的患者的电子病历，包括因 AMA 离开、WBS 离开、ICD-10 编码 Z53.2 或完成就诊的患者。ED 就诊、住院和死亡登记均使用个人识别号码，这使得可以识别索引就诊和结局，包括复诊率、住院率和死亡率。
在 107119 名患者中，77 名 AMA 患者，4471 名 WBS 患者和 423 名 Z53.2 患者。在 30 天内返回 ED 的 HR 为 AMA 患者 4.79，WBS 患者 4.84 和 Z53.2 患者 3.67。在 30 天内住院的 HR 为 AMA 患者 6.90，WBS 患者 1.09 和 Z53.2 患者 1.07。在 30 天内死亡的 HR 为 AMA 患者 10.97，WBS 患者 0.84 和 Z53.2 患者无死亡。
在 30 天的随访期间，与完成 ED 就诊的患者相比，AMA 和 WBS 患者重复 ED 就诊的比例增加。AMA 患者的住院率也有所增加。
