通过救护车送达的呼吸困难患者的流行病学、院前护理及预后：一项观察性研究。
Epidemiology, prehospital care and outcomes of patients arriving by ambulance with dyspnoea: an observational study.
作者信息
Kelly Anne Maree, Holdgate Anna, Keijzers Gerben, Klim Sharon, Graham Colin A, Craig Simon, Kuan Win Sen, Jones Peter, Lawoko Charles, Laribi Said
机构信息
Joseph Epstein Centre for Emergency Medicine Research @ Western Health, Sunshine, Australia.
School of Medicine-Western Clinical School, The University of Melbourne, Parkville, Australia.
出版信息
Scand J Trauma Resusc Emerg Med. 2016 Sep 22;24(1):113. doi: 10.1186/s13049-016-0305-5.
BACKGROUND
This study aimed to determine epidemiology and outcome for patients presenting to emergency departments (ED) with shortness of breath who were transported by ambulance.
METHODS
This was a planned sub-study of a prospective, interrupted time series cohort study conducted at three time points in 2014 and which included consecutive adult patients presenting to the ED with dyspnoea as a main symptom. For this sub-study, additional inclusion criteria were presentation to an ED in Australia or New Zealand and transport by ambulance. The primary outcomes of interest are the epidemiology and outcome of these patients. Analysis was by descriptive statistics and comparisons of proportions.
RESULTS
One thousand seven patients met inclusion criteria. Median age was 74 years (IQR 61-68) and 46.1 % were male. There was a high rate of co-morbidity and chronic medication use. The most common ED diagnoses were lower respiratory tract infection (including pneumonia, 22.7 %), cardiac failure (20.5%) and exacerbation of chronic obstructive pulmonary disease (19.7 %). ED disposition was hospital admission (including ICU) for 76.4 %, ICU admission for 5.6 % and death in ED in 0.9 %. Overall in-hospital mortality among admitted patients was 6.5 %.
DISCUSSION
Patients transported by ambulance with shortness of breath make up a significant proportion of ambulance caseload and have high comorbidity and high hospital admission rate. In this study, >60 % were accounted for by patients with heart failure, lower respiratory tract infection or COPD, but there were a wide range of diagnoses. This has implications for service planning, models of care and paramedic training.
CONCLUSION
This study shows that patients transported to hospital by ambulance with shortness of breath are a complex and seriously ill group with a broad range of diagnoses. Understanding the characteristics of these patients, the range of diagnoses and their outcome can help inform training and planning of services.
背景
本研究旨在确定由救护车转运至急诊科（ED）的气短患者的流行病学特征及治疗结果。
方法
这是一项前瞻性中断时间序列队列研究的计划子研究，于2014年的三个时间点进行，纳入了以呼吸困难为主要症状连续就诊于急诊科的成年患者。对于本项子研究，额外的纳入标准为在澳大利亚或新西兰的急诊科就诊且由救护车转运。主要关注的结果是这些患者的流行病学特征及治疗结果。采用描述性统计和比例比较进行分析。
结果
1700例患者符合纳入标准。中位年龄为74岁（四分位间距61 - 68岁），46.1%为男性。合并症和长期用药率较高。急诊科最常见的诊断为下呼吸道感染（包括肺炎，22.7%）、心力衰竭（20.5%）和慢性阻塞性肺疾病急性加重（19.7%）。急诊科处置情况为76.4%住院（包括重症监护病房）、5.6%入住重症监护病房、0.9%在急诊科死亡。入院患者的总体院内死亡率为6.5%。
讨论
由救护车转运的气短患者占救护车工作量的很大比例，合并症多且住院率高。在本研究中，超过60%为心力衰竭、下呼吸道感染或慢性阻塞性肺疾病患者，但诊断范围广泛。这对服务规划、护理模式和护理人员培训具有重要意义。
结论
本研究表明，由救护车转运至医院的气短患者是一个复杂且病情严重的群体，诊断范围广泛。了解这些患者的特征、诊断范围及其治疗结果有助于为培训和服务规划提供参考。
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