老年和超高龄患者在急诊科就诊时分诊类别、优先级别和住院率的差异。
Differences in triage category, priority level and hospitalization rate between young-old and old-old patients visiting the emergency department.
机构信息
FORS Swiss Centre of Expertise in Social Sciences, University of Lausanne, Géopolis, 1015, Lausanne, Switzerland.
Public Health Department of the Canton of Vaud, Av. des Casernes 2, Lausanne, 1014, Switzerland.
出版信息
BMC Health Serv Res. 2018 Jun 15;18(1):456. doi: 10.1186/s12913-018-3257-9.
BACKGROUND
Emergency Department (ED) are challenged by the increasing number of visits made by the heterogeneous population of elderly persons. This study aims to 1) compare chief complaints (triage categories) and level of priority; 2) to investigate their association with hospitalization after an ED visit; 3) to explore factors explaining the difference in hospitalization rates among community-dwelling older adults aged 65-84 vs 85+ years.
METHODS
All ED visits of patients age 65 and over that occurred between 2005 and 2010 to the University of Lausanne Medical Center were analyzed. Associations of hospitalization with triage categories and level of priority using regressions were compared between the two age groups. Blinder-Oaxaca decomposition was performed to explore how much age-related differences in prevalence of priority level and triage categories contributed to predicted difference in hospitalization rates across the two age groups.
RESULTS
Among 39'178 ED visits, 8'812 (22.5%) occurred in 85+ patients. This group had fewer high priority and more low priority conditions than the younger group. Older patients were more frequently triaged in "Trauma" (20.9 vs 15.0%) and "Home care impossible" (10.1% vs 4.2%) categories, and were more frequently hospitalized after their ED visit (69.1% vs 58.5%). Differences in prevalence of triage categories between the two age groups explained a quarter (26%) of the total age-related difference in hospitalization rates, whereas priority level did not play a role.
CONCLUSIONS
Prevalence of priority level and in triage categories differed across the two age groups but only triage categories contributed moderately to explaining the age-related difference in hospitalization rates after the ED visit. Indeed, most of this difference remained unexplained, suggesting that age itself, besides other unmeasured factors, may play a role in explaining the higher hospitalization rate in patients aged 85+ years.
背景
急诊科（ED）面临着就诊人群中老年人数量不断增加的挑战。本研究旨在：1）比较主要症状（分诊类别）和优先级；2）调查其与 ED 就诊后住院的关系；3）探讨解释 65-84 岁和 85 岁以上社区居住老年人住院率差异的因素。
方法
分析了 2005 年至 2010 年期间在洛桑大学医学中心就诊的所有 65 岁及以上患者的 ED 就诊情况。使用回归比较了两个年龄组中与分诊类别和优先级相关的住院情况。采用 Blinder-Oaxaca 分解法，探讨优先级水平和分诊类别与年龄相关的差异对两个年龄组住院率预测差异的贡献程度。
结果
在 39178 次 ED 就诊中，8812 次（22.5%）发生在 85 岁以上的患者中。与年轻组相比，该组低优先级就诊的比例较高，高优先级就诊的比例较低。老年患者更常被分诊为“创伤”（20.9%比 15.0%）和“无法居家护理”（10.1%比 4.2%）类别，就诊后更常住院（69.1%比 58.5%）。两个年龄组之间分诊类别的差异解释了总住院率与年龄相关差异的四分之一（26%），而优先级水平则没有起到作用。
结论
两个年龄组之间优先级水平和分诊类别的分布不同，但只有分诊类别对解释 ED 就诊后与年龄相关的住院率差异的作用适中。实际上，这种差异的大部分仍未得到解释，这表明除了其他未测量的因素外，年龄本身可能在解释 85 岁以上患者更高的住院率方面发挥作用。
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