Pai Sucheta, Mancuso Carol A, Loganathan Raghu, Boutin-Foster Carla, Basir Riyad, Kanna Balavenkatesh
Department of Internal Medicine, Weill Cornell Medical College , New York, NY , USA .
J Asthma. 2014 Aug;51(6):627-32. doi: 10.3109/02770903.2014.899604. Epub 2014 Mar 27.
Abstract Objective: The objective of this study was to document the frequency and clinical characteristics associated with repeat emergency department (ED) visits for asthma in an inner city population with a high burden of asthma.
During an ED visit for asthma in an inner city hospital ('index visit'), patients completed a valid survey addressing disease and behavioral factors. Hospital records were reviewed for information about ED visits and hospitalizations for asthma during the 12 months before and the 90 days after the index visit.
One hundred and ninety-two patients were enrolled; the mean age was 42 years, 69% were women, 36% were black, 54% were Latino, 69% had Medicaid, and 17% were uninsured. 100 patients (52%) were treated and released from the ED, 88 patients (46%) were hospitalized, and 4 patients (2%) left against medical advice. During the subsequent 90 days, 64 patients (33%) had at least one repeat ED visit for asthma and 27 (14%) were hospitalized for asthma. In a multivariate model, more past ED visits (OR 1.7, 95% CI 1.4, 2.1; p < 0.0001) and male gender (OR 2.5, 95% CI 1.2, 5.4; p = 0.02) remained associated with having a repeat ED visit. Most patients had the first repeat ED visit within 30 days and 18 returned within only 7 days. Among all patients with a repeat visit, those who were not hospitalized for the index visit were more likely to have a repeat visit within 7 days (37%) compared to those who were hospitalized (17%) (p = 0.05 in multivariate analysis).
Repeat ED visits were prevalent among inner city asthma patients and most occurred shortly after the index visit. The strongest predictors of repeat visits were male gender and more ED visits in the 12 months before the index visit.
摘要 目的：本研究的目的是记录内城区哮喘负担较重人群中因哮喘再次就诊于急诊科（ED）的频率及临床特征。
在内城区医院因哮喘就诊于急诊科（“首次就诊”）期间，患者完成了一份关于疾病和行为因素的有效调查问卷。查阅医院记录以获取首次就诊前12个月及之后90天内哮喘患者急诊科就诊和住院的相关信息。
共纳入192例患者；平均年龄为42岁，69%为女性，36%为黑人，54%为拉丁裔，69%有医疗补助，17%未参保。100例患者（52%）在急诊科接受治疗后出院，88例患者（46%）住院，4例患者（2%）自行离院。在随后的90天内，64例患者（33%）因哮喘至少再次就诊于急诊科1次，27例患者（14%）因哮喘住院。在多变量模型中，既往急诊科就诊次数较多（比值比[OR] 1.7，95%置信区间[CI] 1.4, 2.1；p < 0.0001）和男性（OR 2.5，95% CI 1.2, 5.4；p = 0.02）仍然与再次就诊于急诊科相关。大多数患者在30天内首次再次就诊于急诊科，18例患者仅在7天内就再次就诊。在所有再次就诊的患者中，首次就诊未住院的患者比住院患者更有可能在7天内再次就诊（37%对17%）（多变量分析中p = 0.05）。
内城区哮喘患者中再次就诊于急诊科的情况很普遍，且大多数在首次就诊后不久就发生。再次就诊的最强预测因素是男性以及首次就诊前12个月内更多的急诊科就诊次数。
