Moe Jessica, Kirkland Scott, Ospina Maria B, Campbell Sandy, Long Rebecca, Davidson Alan, Duke Patrick, Tamura Tomo, Trahan Lisa, Rowe Brian H
RCPS Emergency Medicine Residency Program, Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.
Emergency Medicine Research Group, University of Alberta, Edmonton, Alberta, Canada.
Emerg Med J. 2016 Mar;33(3):230-6. doi: 10.1136/emermed-2014-204496. Epub 2015 May 7.
This systematic review examines whether frequent emergency department (ED) users experience higher mortality, hospital admissions and outpatient visits than non-frequent ED users.
We published an a priori study protocol in PROSPERO. Our search strategy combined terms for 'frequent users' and 'emergency department'. At least two independent reviewers screened, selected, assessed quality and extracted data. Third-party adjudication resolved conflicts. Results were synthesised based on median effect sizes.
We searched seven electronic databases with no limits and performed an extensive grey literature search.
We included observational analytical studies that focused on adult patients, had a comparison group of non-frequent ED users and reported deaths, admissions and/or outpatient outcomes.
The search strategy identified 4004 citations; 374 were screened by full text and 31 cohort and cross-sectional studies were included. Authors used many different definitions to describe frequent users; the overall quality of the included studies was moderate. Across seven studies examining mortality, frequent users had a median 2.2-fold increased odds of mortality compared with non-frequent users. Twenty-eight studies assessing hospital admissions found a median increased odds of admissions per visit at 1.16 and of admissions per patient at 2.58. Ten studies reported outpatient visits with a median 2.65-fold increased risk of having at least one outpatient encounter post-ED visit.
Frequent ED users appear to experience higher mortality, hospital admissions and outpatient visits compared with non-frequent users, and may benefit from targeted interventions. Standardised definitions to facilitate comparable research are urgently needed.
PROSPERO (CRD42013005855).
本系统评价旨在探讨频繁就诊于急诊科（ED）的患者与非频繁就诊者相比，是否有更高的死亡率、住院率和门诊就诊率。
我们在国际前瞻性系统评价注册库（PROSPERO）上发布了一项预先制定的研究方案。我们的检索策略结合了“频繁使用者”和“急诊科”的检索词。至少两名独立评审员进行筛选、选择、质量评估和数据提取。第三方裁决解决冲突。结果基于效应量中位数进行综合分析。
我们对七个电子数据库进行了无限制检索，并进行了广泛的灰色文献检索。
我们纳入了以成年患者为研究对象的观察性分析研究，设有非频繁急诊科使用者的对照组，并报告了死亡、住院和/或门诊结局。
检索策略共识别出4004条引文；经全文筛选的有374条，纳入了31项队列研究和横断面研究。作者使用了许多不同的定义来描述频繁使用者；纳入研究的总体质量中等。在七项关于死亡率的研究中，频繁使用者的死亡率比非频繁使用者高2.2倍（中位数）。在评估住院率的28项研究中，每次就诊住院率增加1.16倍（中位数），每位患者住院率增加2.58倍（中位数）。十项研究报告了门诊就诊情况，急诊科就诊后至少有一次门诊就诊的风险增加2.65倍（中位数）。
与非频繁使用者相比，频繁急诊科使用者似乎有更高的死亡率、住院率和门诊就诊率，可能受益于有针对性的干预措施。迫切需要标准化定义以促进可比研究。
国际前瞻性系统评价注册库（PROSPERO）（CRD42013005855）
