Clinical Research Center, Soroka University Medical Center, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel.
Clinical Research Center, Soroka University Medical Center, Israel; Medical Intensive Care Unit, Soroka University Medical Center, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel.
J Crit Care. 2018 Feb;43:281-287. doi: 10.1016/j.jcrc.2017.09.177. Epub 2017 Sep 22.
In the emergency department (ED) critically-ill medical patients are treated in the resuscitation room (RR). No studies described the outcomes of critically-ill RR patients admitted to a hospital with low capacity of intensive care unit (ICU) beds.
We included all medical patients above 18 who were admitted to a RR of a tertiary hospital during 2011-2012. We conducted multivariate logistic and Cox regressions and propensity score (PS) matched analysis to analyze parameters associated with the study outcomes.
In-hospital mortality rate was 32.4% in ICU admitted patients compared to 52.0% of the non-ICU critically-ill patients (p<0.001). Age above 80, female and recent ED encounters were associated with non-ICU admissions (p<0.05 for all). ICU admission had a statistically significant effect on in-hospital mortality in PS matched analysis (OR 0.36, 95% CI 0.21-0.61). A marginal effect was evident in one-year survival in PS matched landmark analysis (HR 0.50 95% CI 0.23-1.06).
ED critically-ill medical patients who were treated in the RR had high mortality rates in an institute with restricted ICU beds availability. However, those who were admitted to an ICU showed prolonged short and perhaps long term survival compared to those who were not.
在急诊科（ED），危重症患者在复苏室（RR）接受治疗。目前尚无研究描述在 ICU 床位容量有限的医院中 RR 收治的危重症患者的结局。
我们纳入了 2011 年至 2012 年间在一家三级医院 RR 中收治的所有 18 岁以上的内科患者。我们进行了多变量逻辑回归和 Cox 回归以及倾向评分（PS）匹配分析，以分析与研究结局相关的参数。
在 ICU 收治的患者中，院内死亡率为 32.4%，而非 ICU 收治的危重症患者的死亡率为 52.0%（p<0.001）。年龄>80 岁、女性和近期 ED 就诊与非 ICU 收治相关（p<0.05 均）。在 PS 匹配分析中，ICU 收治对院内死亡率有统计学显著影响（OR 0.36，95%CI 0.21-0.61）。在 PS 匹配里程碑分析中，1 年生存率也有显著的边缘效应（HR 0.50，95%CI 0.23-1.06）。
在 ICU 床位有限的机构中，在 RR 接受治疗的 ED 内科危重症患者死亡率较高。然而，与未收治到 ICU 的患者相比，收治到 ICU 的患者的短期和长期生存时间可能更长。
