美国急诊科鼻出血治疗的差异
Treatment disparities in the management of epistaxis in United States emergency departments.
作者信息
Sethi Rosh K V, Kozin Elliott D, Abt Nicholas B, Bergmark Regan, Gray Stacey T
机构信息
Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.
Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A.
出版信息
Laryngoscope. 2018 Feb;128(2):356-362. doi: 10.1002/lary.26683. Epub 2017 Jul 8.
OBJECTIVES
There is limited data on epistaxis presentation and management patterns in U.S. emergency departments (EDs). We aim to characterize patients who present to the ED with epistaxis and identify factors associated with nasal-packing use.
STUDY DESIGN
Retrospective review of Nationwide Emergency Department Sample (NEDS) from 2009 to 2011.
METHODS
NEDS was queried for patient visits with a primary diagnosis of epistaxis (International Classification of Diseases, Ninth Revision, Clinical Modification code 784.7). Patient demographics, comorbidities, and hospital characteristics were obtained. Predictors of nasal packing were determined by multivariable logistic regression.
RESULTS
There were 1,234,267 ED visits for epistaxis. The highest proportion of patients were seen in the winter (37.2%) at nontrauma hospitals (76.9%), and were discharged home (95.5%). Fifteen percent of patients were on long-term anticoagulation, 33% had hypertension, and 0.9% had a coagulopathy. Nasal packing was utilized in 243,268 patients (19.7%). Predictors strongly associated with nasal packing included lower socioeconomic quartile (odds ratio [OR] 1.30, 95% confidence interval [CI] = 1.10-1.53), hospital located in the geographic South (OR 1.62, CI = 1.12-2.34) and Midwest (OR 1.85, P < 0.0001), and nontrauma hospital (OR 1.56, CI = 1.19-2.05). Other factors included long-term anticoagulation (OR 1.21, CI = 1.10-1.33), winter season (OR 1.20, CI = 1.12-1.23), male gender (OR 1.14, CI = 1.10-1.17), and older age (OR 1.01, CI = 1.01-1.02). Mean ED charge was greater for patients who were packed ($1,473 vs. $1,048, P < 0.0001).
CONCLUSION
Several factors, including lower socioeconomic status, geographic location, and nontrauma hospital designation, predict use of nasal packing. These results raise concerns about potential treatment disparities that may result in increased patient morbidity and costs.
LEVEL OF EVIDENCE
2C. Laryngoscope, 128:356-362, 2018.
目的
关于美国急诊科鼻出血的表现及处理模式的数据有限。我们旨在描述到急诊科就诊的鼻出血患者特征，并确定与使用鼻腔填塞相关的因素。
研究设计
对2009年至2011年全国急诊科样本（NEDS）进行回顾性分析。
方法
查询NEDS中以鼻出血为主要诊断的患者就诊情况（国际疾病分类第九版临床修订本代码784.7）。获取患者人口统计学资料、合并症及医院特征。通过多变量逻辑回归确定鼻腔填塞的预测因素。
结果
因鼻出血到急诊科就诊的患者有1,234,267例。冬季就诊患者比例最高（37.2%），非创伤医院就诊患者占76.9%，且95.5%的患者出院回家。15%的患者正在接受长期抗凝治疗，33%患有高血压，0.9%患有凝血障碍。243,268例患者（19.7%）使用了鼻腔填塞。与鼻腔填塞密切相关的预测因素包括社会经济状况处于较低四分位数（比值比[OR]1.30，95%置信区间[CI]=1.10 - 1.53）、位于南部地区的医院（OR 1.62，CI = 1.12 - 2.34）和中西部地区的医院（OR 1.85，P < 0.0001）以及非创伤医院（OR 1.56，CI = 1.19 - 2.05）。其他因素包括长期抗凝治疗（OR 1.21，CI = 1.10 - 1.33）、冬季（OR 1.20，CI = 1.12 - 1.23）、男性（OR 1.14，CI = 1.10 - 1.17）和年龄较大（OR 1.01，CI = 1.01 - 1.02）。接受鼻腔填塞治疗的患者急诊平均费用更高（1,473美元对1,048美元，P < 0.0001）。
结论
包括社会经济地位较低、地理位置及非创伤医院指定等在内的多个因素可预测鼻腔填塞的使用。这些结果引发了对可能导致患者发病率和费用增加的潜在治疗差异的担忧。
证据级别
2C。《喉镜》，2018年，第128卷，第356 - 362页
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