AMAU 的长期预后：十年经验。

Long-term outcome of an AMAU--a decade's experience.

机构信息

Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland.

出版信息

QJM. 2014 Jan;107(1):43-9. doi: 10.1093/qjmed/hct199. Epub 2013 Sep 30.

DOI:10.1093/qjmed/hct199

PMID:24082153

Abstract

BACKGROUND

There is interest in emergency medical admissions, the outcomes of major reconfigurations and the development of systems and processes for Acute Medicine. We report on the long-term outcomes of an Acute Medical Admissions Unit, using a database of emergency admissions to St James' Hospital, Dublin, from 2002 to 2012.

METHODS

All emergency admissions (67,971 episodes in 37,828 patients) were tracked and in-hospital mortality, length of stay and emergency 'wait' numbers and times summarized. We examined outcomes using generalized estimating equations, an extension of generalized linear models that permitted adjustment for correlated observations (readmissions). Margins statistics used adjusted predictions to test for interactions of key predictors while controlling for other variables using computations of the average marginal effect.

RESULTS

By episode, the in-hospital mortality averaged 5.8% (95% CI 5.6-5.9%); the relative risk reduction (RRR) was 35.0% between 2002 and 2012, from 7.0% to 4.6% (P = 0.001), with a number needed to treat (NNT) of 40.7. By unique patient the in-hospital mortality averaged 10.3% (95% CI 10.0-10.6%) with a RRR of 60.0% from 14.5% to 5.7% (P = 0.001), with an NNT of 11.4. Emergency Department 'wait' numbers decreased by 43%. The main mortality outcome predictors were Illness Severity, Charlson Comorbidity, Manchester Triage Category, O2 saturation, blood culture results, transfusion requirement and a primary respiratory or neurological diagnosis; the model had a high AUROC of 0.88 (95% CI 0.87, 0.88).

CONCLUSION

Institution reform can result in substantial outcome and process measure benefits, improving care delivery to emergency medical admissions.

摘要

背景

人们对急诊入院、重大改组的结果以及急性医学的系统和流程的发展很感兴趣。我们使用都柏林圣詹姆斯医院 2002 年至 2012 年的急诊入院数据库报告了急性内科住院医师的长期结果。

方法

所有急诊入院（37828 名患者中有 67971 例）均进行了跟踪，住院死亡率、住院时间和急诊“等待”人数和时间进行了总结。我们使用广义估计方程（广义线性模型的扩展，允许对相关观察值（再入院）进行调整）来检查结果。边际统计数据使用调整后的预测值来检验关键预测因子的相互作用，同时通过计算平均边际效应来控制其他变量。

结果

以每例计算，住院死亡率平均为 5.8%（95%置信区间 5.6-5.9%）；2002 年至 2012 年，相对风险降低（RRR）为 35.0%，从 7.0%降至 4.6%（P=0.001），需要治疗的人数（NNT）为 40.7。以每位患者计算，住院死亡率平均为 10.3%（95%置信区间 10.0-10.6%），RRR 为 60.0%，从 14.5%降至 5.7%（P=0.001），NNT 为 11.4。急诊部“等待”人数减少了 43%。主要死亡率预测因子为疾病严重程度、Charlson 合并症、曼彻斯特分诊类别、O2 饱和度、血培养结果、输血需求以及原发性呼吸系统或神经系统诊断；该模型的 AUC 为 0.88（95%置信区间 0.87，0.88）。