Institute of Health and Environment, Seoul National University Graduate School of Public Health, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Korea.
Department of Preventive Medicine, College of Medicine, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea.
Int J Environ Res Public Health. 2018 Jun 5;15(6):1178. doi: 10.3390/ijerph15061178.
Hospital-acquired pneumonia (HAP) is an inflammatory condition of the lung that develops at least 48⁻72 h after admission. HAP is contracted by both intensive care unit (ICU) and non-ICU patients, but no studies have examined the risk of HAP in patients admitted to the emergency department (ED). This study investigated the risk of developing HAP in ED patients and compared the occurrence of HAP 3⁻10 days after the first day of hospitalization in patients hospitalized via ED with those hospitalized via outpatient clinics. We analyzed the 2010 National Inpatient Sample data collected by the Health Insurance Review and Assessment Service in South Korea. After propensity score matching for age, sex, residential area, hospital, and diseases, 153,130 inpatients (76,565 admitted via ED and 76,565 admitted via outpatient clinics) were included in the analysis. The diagnosis of pneumonia was based on the International Classification of Diseases and Related Health Problems 10th Revision (Pneumonia, all (J12⁻J18); Pneumonia, bacterial (J13⁻J15); Pneumonia, non-bacterial (J12, J16, J17); and Pneumonia, unspecified (J18)). The percentage of newly diagnosed cases of pneumonia in inpatients admitted via ED was significantly higher than that in inpatients admitted via outpatient clinics. After propensity score matching for baseline characteristics, the likelihood of developing pneumonia (excluding the category of 'Pneumonia, non-bacterial') in inpatients hospitalized via ED was significantly increased by 1.33⁻1.97-fold. The cumulative incidence of pneumonia was also significantly higher in patients admitted via ED than in those hospitalized via outpatient clinics. ED visits may be an important risk factor for the development of HAP.
医院获得性肺炎（HAP）是一种在入院后至少 48-72 小时发生的肺部炎症性疾病。HAP 可发生于重症监护病房（ICU）和非 ICU 患者中，但尚无研究探讨急诊（ED）患者中 HAP 的发病风险。本研究调查了 ED 患者发生 HAP 的风险，并比较了通过 ED 住院和通过门诊住院的患者在住院第 1 天之后的第 3-10 天发生 HAP 的情况。我们分析了韩国健康保险审查与评估服务收集的 2010 年国家住院患者样本数据。在对年龄、性别、居住地区、医院和疾病进行倾向评分匹配后，纳入 153130 例住院患者（76565 例通过 ED 住院，76565 例通过门诊住院）进行分析。肺炎的诊断依据为国际疾病分类第 10 版（肺炎，所有（J12-J18）；细菌性肺炎（J13-J15）；非细菌性肺炎（J12、J16、J17）；未特指肺炎（J18））。通过 ED 住院的患者中新诊断肺炎的比例明显高于通过门诊住院的患者。在对基线特征进行倾向评分匹配后，通过 ED 住院的患者发生肺炎（不包括“非细菌性肺炎”类别）的可能性显著增加了 1.33-1.97 倍。ED 就诊的患者发生肺炎的累积发病率也明显高于通过门诊住院的患者。ED 就诊可能是 HAP 发展的一个重要危险因素。
