Penn State College of Medicine, 435 Northstar Dr., Harrisburg, PA, 17112, USA.
Department of Emergency Medicine, Penn State College of Medicine, Hershey, PA, USA.
Intern Emerg Med. 2018 Sep;13(6):893-900. doi: 10.1007/s11739-018-1792-3. Epub 2018 Jan 29.
Patients' overestimation of their illness severity appears to contribute to the national epidemic of emergency department (ED) overcrowding. This study aims to elucidate which patient populations are more likely to have a higher estimation of illness severity (EIS). The investigator surveyed demographic factors of all non-urgent patients at an academic ED. The patients and physicians were asked to estimate the patients' illness severity using a 1-10 scale with anchors. The difference of these values was taken and compared across patient demographic subgroups using a 2-sample t-test. One hundred and seventeen patients were surveyed. The mean patient EIS was 5.22 (IQR 4), while the mean physician EIS was less severe at 7.57 (IQR 3), a difference of 2.35 (p < 0.0001). Patient subgroups with the highest EIS compared to the physicians' EIS include those who were self-referred (difference of 2.65, p = 0.042), with income ≤ $25,000 (difference of 2.96, p = 0.004), with less than a college education (difference of 2.83, p = 0.018), and with acute-on-chronic musculoskeletal pain (difference of 4.17, p = 0.001). If we assume the physicians' EIS is closer to the true illness severity, patients with lower socioeconomic status, lower education status, who were self-referred, and who suffered from acute-on-chronic musculoskeletal pain are more likely to overestimate their illness severity and may contribute to non-urgent use of the ED. They may benefit from further education or resources for care to prevent ED misuse. The large difference of acute-on-chronic musculoskeletal pain may reflect a physician's bias to underestimate the severity of a patients' illness in this particular population.
患者对自身疾病严重程度的高估似乎是导致全国急诊部门（ED）过度拥挤的原因之一。本研究旨在阐明哪些患者群体更有可能高估疾病严重程度（EIS）。研究者调查了一家学术 ED 的所有非紧急患者的人口统计学因素。让患者和医生使用带有锚定的 1-10 刻度来估计患者的疾病严重程度。通过两样本 t 检验，比较这些数值在患者人口统计学亚组之间的差异。调查了 117 名患者。患者的平均 EIS 为 5.22（IQR 4），而医生的 EIS 较轻，为 7.57（IQR 3），差异为 2.35（p<0.0001）。与医生的 EIS 相比，EIS 最高的患者亚组包括自我转诊的患者（差异为 2.65，p=0.042）、收入≤25000 美元的患者（差异为 2.96，p=0.004）、受教育程度低于大学的患者（差异为 2.83，p=0.018）以及患有急性加重的慢性肌肉骨骼疼痛的患者（差异为 4.17，p=0.001）。如果我们假设医生的 EIS 更接近真实的疾病严重程度，那么社会经济地位较低、教育程度较低、自我转诊以及患有急性加重的慢性肌肉骨骼疼痛的患者更有可能高估自己的疾病严重程度，并且可能导致非紧急使用 ED。他们可能需要进一步的教育或护理资源，以防止 ED 的滥用。急性加重的慢性肌肉骨骼疼痛的差异很大，可能反映了医生在该特定人群中低估患者疾病严重程度的偏见。
