1Department of Preventive Medicine, University of Iceland, Reykjavik, Iceland.
Scand J Public Health. 2013 Dec;41(8):832-8. doi: 10.1177/1403494813499460. Epub 2013 Aug 1.
The aim of the study was to evaluate the association of death within 8-30 days after discharge home from the emergency department with a non-causative diagnosis in a prospective cohort study.
The 227,097 visits to the emergency department were filed by personal identification number and included information on gender, age, admission, discharge, and diagnosis. The visits were classified by main diagnosis at discharge into those with non-causative diagnosis and those with other diagnoses. Mortality per 100,000 within 8, 15 and 30 days and the corresponding hazard ratio (HR) and 95% confidence intervals (CI) were calculated for all causes of death and for selected causes of death in a time-dependent analysis.
The HRs of all causes of death for patients with a non-causative diagnosis were 0.64 (95% CI 0.41-1.01) within 8 days, 0.70 (95% CI 0.50-0.99) within 15 days, and 0.82 (95% CI 0.65-1.04) within 30 days as compared to those with a causative diagnosis. The HRs within 30 days among those with a non-causative diagnosis at discharge were 1.48 (95% CI 1.03-2.13) for malignant neoplasm, 3.72 (95% CI 1.44-9.60) for suicide, and 0.50 (95% CI 0.32-0.79) for diseases of the circulatory system.
Death within 8 days after discharge home from the ED is a rare event. Death of patients that occur shortly after discharge who had received a non-causative diagnosis as the main diagnosis may indicate a misjudgement of the patients' condition at that time.
本研究旨在通过前瞻性队列研究评估急诊科出院后 8-30 天内死亡与非病因诊断之间的关联。
通过个人身份识别号码对 227097 次急诊科就诊进行归档，并纳入性别、年龄、入院、出院和诊断信息。根据出院时的主要诊断，将就诊分为具有非病因诊断和其他诊断的就诊。计算了所有死因和特定死因在 8、15 和 30 天内每 10 万人的死亡率以及相应的风险比（HR）和 95%置信区间（CI）。在时间依赖性分析中，对所有死因和特定死因进行了分析。
与病因诊断相比，具有非病因诊断的患者在 8 天内、15 天内和 30 天内所有死因的 HR 分别为 0.64（95%CI 0.41-1.01）、0.70（95%CI 0.50-0.99）和 0.82（95%CI 0.65-1.04）。在出院时具有非病因诊断的患者中，30 天内的 HR 为恶性肿瘤 1.48（95%CI 1.03-2.13）、自杀 3.72（95%CI 1.44-9.60）和循环系统疾病 0.50（95%CI 0.32-0.79）。
急诊科出院后 8 天内死亡是罕见事件。出院后不久因非病因诊断为主要诊断而死亡的患者，可能表明当时对患者病情的判断有误。
