Shen Yuzeng, Tay Yee Chien, Teo Edward Wee Kwan, Liu Nan, Lam Shao Wei, Ong Marcus Eng Hock
Department of Emergency Medicine, Singapore General Hospital, Singapore.
Department of Emergency Medicine, Sengkang Health, Singapore.
World J Emerg Med. 2018;9(1):20-25. doi: 10.5847/wjem.j.1920-8642.2018.01.003.
To determine if elderly frequent attenders are associated with increased 30-day mortality, assess resource utilization by the elderly frequent attenders and identify associated characteristics that contribute to mortality.
Retrospective observational study of electronic clinical records of all emergency department (ED) visits over a 10-year period to an urban tertiary general hospital in Singapore. Patients aged 65 years and older, with 3 or more visits within a calendar year were identified. Outcomes measured include 30-day mortality, admission rate, admission diagnosis and duration spent at ED. Chi-square-tests were used to assess categorical factors and Student -test was used to assess continuous variables on their association with being a frequent attender. Univariate and multivariate logistic regressions were conducted on all significant independent factors on to the outcome variable (30-day mortality), to determine factor independent odds ratios of being a frequent attender.
1.381 million attendance records were analyzed. Elderly patients accounted for 25.5% of all attendances, of which 31.3% are frequent attenders. Their 30-day mortality rate increased from 4.0% in the first visit, to 8.8% in the third visit, peaking at 10.2% in the sixth visit. Factors associated with mortality include patients with neoplasms, ambulance utilization, male gender and having attended the ED the previous year.
Elderly attenders have a higher 30-day mortality risk compared to the overall ED population, with mortality risk more marked for frequent attenders. This study illustrates the importance and need for interventions to address frequent ED visits by the elderly, especially in an aging society.
确定老年频繁就诊者是否与30天死亡率增加相关，评估老年频繁就诊者的资源利用情况，并确定导致死亡率的相关特征。
对新加坡一家城市三级综合医院10年间所有急诊科就诊的电子临床记录进行回顾性观察研究。确定年龄在65岁及以上、在一个日历年内就诊3次或更多次的患者。测量的结果包括30天死亡率、入院率、入院诊断和在急诊科的停留时间。采用卡方检验评估分类因素，采用学生t检验评估连续变量与频繁就诊者的相关性。对所有与结局变量（30天死亡率）相关的显著独立因素进行单变量和多变量逻辑回归，以确定频繁就诊者的因素独立比值比。
分析了138.1万份就诊记录。老年患者占所有就诊人数的25.5%，其中31.3%为频繁就诊者。他们的30天死亡率从首次就诊时的4.0%上升到第三次就诊时的8.8%，在第六次就诊时达到峰值10.2%。与死亡率相关的因素包括患有肿瘤的患者、使用救护车、男性以及前一年去过急诊科。
与整个急诊科人群相比，老年就诊者的30天死亡风险更高，频繁就诊者的死亡风险更为明显。本研究说明了干预措施对于解决老年人频繁就诊问题的重要性和必要性，尤其是在老龄化社会中。
