以非特异性症状就诊的老年急诊患者：特征与结局

Elderly emergency patients presenting with non-specific complaints: Characteristics and outcomes.

作者信息

Wachelder Joyce J H, Stassen Patricia M, Hubens Laura P A M, Brouns Steffie H A, Lambooij Suze L E, Dieleman Jeanne P, Haak Harm R

机构信息

Department of Internal Medicine, Máxima Medical Centre, Eindhoven, the Netherlands.

Department of Health Services Research, and CAPHRI School for Public Health and Primary Care, Maastricht, the Netherlands.

出版信息

PLoS One. 2017 Nov 30;12(11):e0188954. doi: 10.1371/journal.pone.0188954. eCollection 2017.

DOI:10.1371/journal.pone.0188954

PMID:29190706

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5708794/

Abstract

BACKGROUND

Non-specific complaints (NSC) are common at the emergency department, but only a few studies have shown evidence that these complaints are associated with a poor prognosis in elderly emergency patients.

OBJECTIVE

To describe patient characteristics and outcomes in a cohort of elderly emergency patients presenting with NSC. Outcomes were: patient characteristics, hospitalization, 90-day ED-return visits, and 30-day mortality.

METHOD

A retrospective cohort study was conducted amongst elderly patients present to the Internal Medicine Emergency Department (ED) between 01-09-2010 and 31-08-2011. NSC were defined as indefinable complaints that lack a pre-differential diagnosis needed to initiate of a standardized patient evaluation. Cox regression was performed to calculate Hazard Ratios (HR) and corrected for confounders such as comorbidity.

RESULTS

In total, 1784 patients were enrolled; 244 (13.7%) presented with NSC. Compared to those with SC, comorbidity was higher in the NSC-group (Charlson comorbidity index 3.0 vs. 2.4, p<0.001). The triage level did not differ, but ED-length of stay was longer in the NSC-group (188 vs. 178 minutes, p = 0.004). Hospitalization was more frequent (84.0 vs. 71.1%, p<0.001) and the length of hospital stay (9 vs. 6 days, p<0.001 was longer in the NSC- than in the SC-group. The number of ED-return visits were comparable between both groups (HR 0.8, 95%CI 0.6-1.1). Mortality within 30-days was higher in the NSC- (20.1%) than in the SC-group (11.0%, HR 1.7 95%CI 1.2-2.4).

CONCLUSION

Elderly patients present with NSC at the ED regularly. These patients are more often hospitalized and have a substantially higher 30-day mortality than patients with SC.

摘要

背景

非特异性主诉（NSC）在急诊科很常见，但只有少数研究表明这些主诉与老年急诊患者的不良预后相关。

目的

描述一组出现NSC的老年急诊患者的特征和结局。结局指标包括：患者特征、住院情况、90天内急诊复诊情况以及30天死亡率。

方法

对2010年9月1日至2011年8月31日期间到内科急诊科就诊的老年患者进行回顾性队列研究。NSC被定义为无法明确诊断且缺乏启动标准化患者评估所需的鉴别诊断的主诉。采用Cox回归计算风险比（HR），并对合并症等混杂因素进行校正。

结果

共纳入1784例患者；244例（13.7%）出现NSC。与有特异性主诉（SC）的患者相比，NSC组的合并症更多（Charlson合并症指数3.0对2.4，p<0.001）。分诊级别无差异，但NSC组的急诊留观时间更长（188分钟对178分钟，p = 0.004）。NSC组住院更频繁（84.0%对71.1%，p<0.001），住院时间更长（9天对6天，p<0.001）。两组的急诊复诊次数相当（HR 0.8，95%CI 0.6 - 1.1）。NSC组30天内的死亡率高于SC组（20.1%对11.0%，HR 1.7，95%CI 1.2 - 2.4）。