Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan.
Geriatr Gerontol Int. 2017 Dec;17(12):2441-2448. doi: 10.1111/ggi.13098. Epub 2017 Jun 18.
We aimed to investigate prehospital factors associated with difficulty in hospital acceptance among elderly emergency patients.
We reviewed ambulance records in Osaka City from January 2013 through December 2014, and enrolled all elderly emergency patients aged ≥65 years who were transported by on-scene emergency medical service personnel to a hospital that the personnel had selected. The definition of difficulty in hospital acceptance was to the requirement for ≥4 phone calls to hospitals by emergency medical service personnel before receiving a decision from the destination hospitals. Prehospital factors associated with difficulty in hospital acceptance were examined through logistic regression analysis.
During the study period, 72 105 elderly patients were included, and 13 332 patients (18.5%) experienced difficulty in hospital acceptance. In the simple linear regression model, hospital selection time increased significantly with an increasing number of phone calls (R = 0.774). In the multivariable analysis, older age (P for trend <0.001), calls from a healthcare facility (adjusted odds ratio [AOR] 1.23, 95% confidence interval [CI] 1.15-1.32), night-time (AOR 2.17, 95% CI 2.08-2.26) and weekend/holidays (AOR 1.43, 95% CI 1.38-1.49) were significantly associated with difficulty in hospital acceptance. A positive association was observed between gastrointestinal emergency-related symptoms and difficulty in hospital acceptance among elderly patients with symptoms of internal disease (AOR 1.71, 95% CI 1.53-1.91).
In Japan, which has a rapidly aging population, a comprehensive strategy for elderly emergency patients, especially for advanced age groups or nursing home residents, is required. Geriatr Gerontol Int 2017; 17: 2441-2448.
我们旨在研究与老年急诊患者住院困难相关的院前因素。
我们回顾了 2013 年 1 月至 2014 年 12 月期间大阪市的救护车记录，并纳入了所有由现场急救医疗服务人员送往人员选定的医院的 65 岁及以上的老年急诊患者。住院困难的定义为急救医疗服务人员向目的地医院打 4 通及以上电话后，才接到医院的决定。通过 logistic 回归分析来检查与住院困难相关的院前因素。
在研究期间，共纳入了 72105 名老年患者，其中 13332 名患者（18.5%）经历了住院困难。在简单线性回归模型中，随着电话次数的增加，医院选择时间显著增加（R = 0.774）。在多变量分析中，年龄较大（趋势 P <0.001）、来自医疗机构的电话（调整优势比[OR]1.23，95%置信区间[CI]1.15-1.32）、夜间（OR 2.17，95%CI 2.08-2.26）和周末/节假日（OR 1.43，95%CI 1.38-1.49）与住院困难显著相关。在有内科疾病症状的老年患者中，胃肠道急症相关症状与住院困难呈正相关（OR 1.71，95%CI 1.53-1.91）。
在人口迅速老龄化的日本，需要针对老年急诊患者制定综合策略，特别是针对高龄患者或养老院居民。
