Jo Sion, Jeong Taeoh, Jin Young Ho, Lee Jae Baek, Yoon Jaechol, Park Boyoung
Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University, Jeonju-si, Jeollabuk-do, Republic of Korea; Chonbuk National University Hospital, Jeonju-si, Jeollabuk-do, Republic of Korea.
National Cancer Control Institute, National Cancer Center, Goyang-si, Kyunggi-do, Republic of Korea.
Am J Emerg Med. 2015 Dec;33(12):1725-31. doi: 10.1016/j.ajem.2015.08.004. Epub 2015 Aug 7.
Adverse effects of emergency department (ED) crowding among critically ill patients are not well known.
We evaluated the association between ED crowding and inpatient mortality among critically ill patients admitted via the ED, and analyzed subsets of patients according to admission diagnosis.
We performed a post hoc analysis using data from a previous retrospective study. We enrolled admitted patients via the ED with an initial systolic blood pressure of 90 mm Hg or lower when presenting to the ED. The ED occupancy ratio was used as a measure of crowding. The primary outcome was inpatient mortality. Multivariable logistic regression models adjusted for potential confounding variables were constructed for the entire cohort and for subsets according to admission diagnosis (infection, cardiac and vascular disease, trauma, gastrointestinal bleeding, and other factors).
A total of 1801 patients were enrolled, with a mortality rate of 14.6% (262 patients). The mortality rate by ED occupancy ratio quartile was 9.7% for the first quartile, 15.9% for the second quartile, 18.2% for the third quartile, and 14.4% for the fourth quartile. This resulted in adjusted odds ratios of 1.95, 2.51, and 1.93 and corresponding 95% confidence intervals of 1.23-3.12, 1.58-3.99, and 1.21-3.09 for the second, third, and fourth quartiles, respectively, compared with the first quartile. The effect of ED crowding was highest in the trauma subset, followed by the infection subset, whereas ED crowding did not appear to have any effect on the cardiac and vascular disease subsets.
Emergency department crowding was associated with increased inpatient mortality among critically ill patients admitted via the ED.
急诊科拥挤对重症患者的不良影响尚不为人所知。
我们评估了通过急诊科收治的重症患者中，急诊科拥挤与住院死亡率之间的关联，并根据入院诊断对患者亚组进行了分析。
我们使用了先前一项回顾性研究的数据进行事后分析。纳入通过急诊科收治的患者，这些患者在就诊时初始收缩压为90毫米汞柱或更低。急诊科占用率用作拥挤程度的衡量指标。主要结局是住院死亡率。针对整个队列以及根据入院诊断（感染、心血管疾病、创伤、胃肠道出血和其他因素）划分的亚组，构建了调整潜在混杂变量的多变量逻辑回归模型。
共纳入1801例患者，死亡率为14.6%（262例患者）。按急诊科占用率四分位数划分的死亡率，第一四分位数为9.7%，第二四分位数为15.9%，第三四分位数为18.2%，第四四分位数为14.4%。与第一四分位数相比，第二、第三和第四四分位数的调整比值比分别为1.95、2.51和1.93，相应的95%置信区间分别为1.23 - 3.12、1.58 - 3.99和1.21 - 3.09。急诊科拥挤的影响在创伤亚组中最高，其次是感染亚组，而急诊科拥挤似乎对心血管疾病亚组没有任何影响。
急诊科拥挤与通过急诊科收治的重症患者住院死亡率增加有关。
