Hill Jesse, Arrotta Nicholas, Villa-Roel Cristina, Dennett Liz, Rowe Brian H
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.
Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada; School of Medicine, Trinity College Dublin, Dublin, Ireland.
BMJ Open Respir Res. 2017 Jan 27;4(1):e000169. doi: 10.1136/bmjresp-2016-000169. eCollection 2017.
A significant proportion of patients discharged from the emergency department (ED) with asthma exacerbations will relapse within 4 weeks. This systematic review summarises the evidence regarding relapses and factors associated with relapse in adult patients discharged from EDs after being treated for acute asthma. Following a registered protocol, comprehensive literature searches were conducted. Studies tracking outcomes for adults after ED management and discharge were included if they involved adjusted analyses. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS) and the Risk of Bias (RoB) Tool. Results were summarised using medians and IQRs or mean and SD, as appropriate. 178 articles underwent full-text review and 10 studies, of various methodologies, involving 32 923 patients were included. The majority of the studies were of high quality according to NOS and RoB Tool. Relapse proportions were 8±3%, 12±4% and 14±6% at 1, 2 and 4 weeks, respectively. Female sex was the most commonly reported and statistically significant factor associated with an increased risk of relapse within 4 weeks of ED discharge for acute asthma. Other factors significantly associated with relapse were past healthcare usage and previous inhaled corticosteroids (ICS) usage. A median of 17% of patients who are discharged from the ED will relapse within the first 4 weeks. Factors such as female sex, past healthcare usage and ICS use at presentation were commonly and significantly associated with relapse occurrence. Identifying patients with these features could provide clinicians with guidance during their ED discharge decision-making.
相当一部分因哮喘急性加重而从急诊科出院的患者会在4周内复发。本系统评价总结了关于急性哮喘治疗后从急诊科出院的成年患者复发情况及复发相关因素的证据。按照注册方案进行了全面的文献检索。纳入了对急诊科处理和出院后成年患者结局进行追踪且涉及校正分析的研究。使用纽卡斯尔-渥太华量表（NOS）和偏倚风险（RoB）工具评估方法学质量。结果根据情况使用中位数和四分位间距或均值和标准差进行总结。178篇文章接受了全文审查，纳入了10项方法各异、涉及32923例患者的研究。根据NOS和RoB工具，大多数研究质量较高。复发率在1周、2周和4周时分别为8±3%、12±4%和14±6%。女性是最常报告且在统计学上与急性哮喘急诊科出院后4周内复发风险增加相关的因素。其他与复发显著相关的因素是既往医疗服务利用情况和既往吸入性糖皮质激素（ICS）使用情况。从急诊科出院的患者中，中位数为17%会在最初4周内复发。女性、既往医疗服务利用情况以及就诊时ICS使用情况等因素通常与复发的发生显著相关。识别具有这些特征的患者可为临床医生在急诊科出院决策过程中提供指导。
