急诊室候诊时间与重症监护病房收治患者结局的相关性。

The association of duration of boarding in the emergency room and the outcome of patients admitted to the intensive care unit.

作者信息

Al-Qahtani Saad, Alsultan Abdullah, Haddad Samir, Alsaawi Abdulmohsen, Alshehri Moeed, Alsolamy Sami, Felebaman Afef, Tamim Hani M, Aljerian Nawfal, Al-Dawood Abdulaziz, Arabi Yaseen

机构信息

Intensive Care Department, King Abdulaziz Medical City, P.O. Box 22490, Riyadh, 11426, Saudi Arabia.

King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

出版信息

BMC Emerg Med. 2017 Nov 9;17(1):34. doi: 10.1186/s12873-017-0143-4.

DOI:10.1186/s12873-017-0143-4

PMID:29121883

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5680599/

Abstract

BACKGROUND

The demand for critical care beds is increasing out of proportion to bed availability. As a result, some critically ill patients are kept in the Emergency Department (ED boarding) awaiting bed availability. The aim of our study is to examine the impact of boarding in the ED on the outcome of patients admitted to the Intensive Care Unit(ICU).

METHODS

This was a retrospective analysis of ICU data collected prospectively at King Abdulaziz Medical City, Riyadh from ED between January 2010 and December 2012 and all patients admitted during this time were evaluated for their duration of boarding. Patients were stratified into three groups according to the duration of boarding from ED. Those admitted less than 6 h were classified as Group I, between 6 and 24 h, Group II and more than 24 h as Group III. We carried out multivariate analysis to examine the independent association of boarding time with the outcome adjusting for variables like age, sex, APACHE, Mechanical ventilation, Creatinine, Platelets, INR.

RESULTS

During the study period, 940 patients were admitted from the ED to ICU, amongst whom 227 (25%) were admitted to ICU within 6 h, 358 (39%) within 6-24 h and 355 (38%) after 24 h. Patients admitted to ICU within 6 h were younger [48.7 ± 22.2(group I) years, 50.6 ± 22.6 (group II), 58.2 ± 20.9 (group III) (P = 0.04)]with less mechanical ventilation duration[5.9 ± 8.9 days (Group I), 6.5 ± 8.1 (Group II) and 10.6 ± 10.5 (Group III), P = 0.04]. There was a significant increase in hospital mortality [51(22.5), 104(29.1), 132(37.2), P = 0.0006) and the ICU length of stay(LOS) [9.55 days (Group I), 9.8 (Group II) and 10.6 (Group III), (P = 0.002)] with increase in boarding duration. In addition, the delay in admission was an independent risk factor for ICU mortality(OR for group III vs group I is 1.90, P = 0.04) and hospital mortality(OR for group III vs Group I is 2.09, P = 0.007).

CONCLUSION

Boarding in the ED is associated with higher mortality. This data highlights the importance of this phenomenon and suggests the need for urgent measures to reduce boarding and to improve patient flow.

摘要

背景

重症监护病床的需求增长与床位供应不成比例。因此，一些重症患者被留在急诊科（急诊留观）等待床位。我们研究的目的是探讨急诊留观对入住重症监护病房（ICU）患者结局的影响。

方法

这是一项对2010年1月至2012年12月在利雅得阿卜杜勒阿齐兹国王医疗城急诊科前瞻性收集的ICU数据进行的回顾性分析，对在此期间所有入住的患者的留观时间进行评估。根据从急诊科留观的时间将患者分为三组。留观时间少于6小时的患者归为I组，6至24小时的归为II组，超过24小时的归为III组。我们进行多变量分析，以检验留观时间与结局之间的独立关联，并对年龄、性别、急性生理与慢性健康状况评分系统（APACHE）、机械通气、肌酐、血小板、国际标准化比值（INR）等变量进行校正。

结果

在研究期间，940例患者从急诊科入住ICU，其中227例（25%）在6小时内入住ICU，358例（39%）在6至24小时内入住，355例（38%）在24小时后入住。6小时内入住ICU的患者更年轻[48.7±22.2（I组）岁，50.6±22.6（II组）岁，58.2±20.9（III组）岁（P = 0.04）]，机械通气时间更短[5.9±8.9天（I组），6.5±8.1天（II组），10.6±10.5天（III组），P = 0.04]。随着留观时间的增加，医院死亡率[51例（22.5%），104例（29.1%），132例（37.2%），P = 0.0006]和ICU住院时间（LOS）[9.55天（I组），9.8天（II组），10.6天（III组），（P = 0.002）]显著增加。此外，延迟入院是ICU死亡率（III组与I组的比值比为1.90，P = 0.04）和医院死亡率（III组与I组的比值比为2.09，P = 0.007）的独立危险因素。