Weigel Karin, Nickel Christian H, Malinovska Alexandra, Bingisser Roland
Emergency Department, University Hospital Basel, Switzerland.
Department of Internal Medicine, University Hospital Basel, Switzerland.
Int J Clin Pract. 2018 Jan;72(1). doi: 10.1111/ijcp.13033. Epub 2017 Oct 26.
The type and number of symptoms in emergency patients differ widely. It remains unclear, if outcomes can be predicted by the number of symptoms. Furthermore, it is unknown, whether clinical practice could be influenced by presenting symptoms.
Prospective observational study, performed in the emergency department of the University Hospital Basel, a tertiary hospital. A consecutive sample of patients was interviewed at presentation for a predefined set of 35 symptoms. The number of symptoms was correlated with outcomes using linear and logistic regression models. Clinical practice was observed using prospective data on disease severity ratings, triage category, use of resources, length-of-stay and follow-up presentations.
Data of 3472 patients were analysed. The number of symptoms ranged between 1 and 25, the mean being 2.74. Women reported more symptoms than men. Age and comorbidity indices were not associated with the number of symptoms. After adjusting for age and gender, there was no correlation between the number of symptoms and adverse outcomes, such as ICU-admission or in-hospital mortality (OR: 1.03, CI: 0.88-1.18, P = .68). The number of symptoms at presentation was associated with hospitalisation, disease severity rating by patients and emergency physicians, triage categories, use of resources, length-of-stay and follow-up presentations.
The number of symptoms did not correlate with the main adverse outcomes (ICU-admission and in-hospital mortality). However, clinical practice was influenced by the nature and number of symptoms. This was shown by associations with hospitalisation, length-of-stay, use of resources and follow-up presentations. Furthermore, the number of symptoms correlated with the caregivers' disease severity ratings and the attributed triage categories. This may indicate that caregivers respond to the number of symptoms by a higher investment in their immediate work-ups and later follow-ups.
急诊患者的症状类型和数量差异很大。症状数量能否预测预后尚不清楚。此外，目前尚不清楚临床表现是否会影响临床实践。
在巴塞尔大学医院急诊科进行的一项前瞻性观察研究，该医院为三级医院。连续选取患者样本，在就诊时询问一组预先定义的35种症状。使用线性和逻辑回归模型将症状数量与预后进行关联分析。通过关于疾病严重程度评级、分诊类别、资源使用、住院时间和随访就诊的前瞻性数据观察临床实践。
分析了3472例患者的数据。症状数量在1至25之间，平均为2.74。女性报告的症状比男性多。年龄和合并症指数与症状数量无关。在调整年龄和性别后，症状数量与不良预后（如入住重症监护病房或住院死亡率）之间无相关性（OR：1.03，CI：0.88 - 1.18，P = 0.68）。就诊时的症状数量与住院、患者和急诊医生评定的疾病严重程度、分诊类别、资源使用、住院时间和随访就诊相关。
症状数量与主要不良预后（入住重症监护病房和住院死亡率）无关。然而，临床实践受到症状的性质和数量的影响。这体现在与住院、住院时间、资源使用和随访就诊的关联上。此外，症状数量与医护人员评定的疾病严重程度和分诊类别相关。这可能表明医护人员会根据症状数量在即刻检查和后续随访中投入更多精力。
