三家独立急诊部与一家三级护理医院急诊部的危重症患者比较。
Comparison of critically ill patients from three freestanding ED's compared to a tertiary care hospital based ED.
机构信息
Cleveland Clinic Akron General, Department of Emergency Medicine, United States.
Cleveland Clinic Akron General, Department of Emergency Medicine, United States.
出版信息
Am J Emerg Med. 2019 Jul;37(7):1307-1312. doi: 10.1016/j.ajem.2018.10.006. Epub 2018 Oct 11.
BACKGROUND
Freestanding emergency departments (FEDs) care for all patients, including critically ill, 24/7/365. We characterized patients from three FEDs transferred to intensive care units (ICU) at a tertiary care hospital, and compared hospital length of stay(LOS) between patients admitted to ICUs from FEDs versus a hospital-based ED (HBED).
METHODS
We performed a retrospective, observational cohort study from January 2014 to December 2016. Demographic and clinical information was compared between FED and HBED patients with chi-square and fisher's exact tests for categorical variables and Student's t-test for continuous variables. The main outcome of interest was hospital LOS. Multi-variable linear regression was performed to estimate association between LOS and emergency facility type, while adjusting for potential confounders.
RESULTS
We included 500 critically ill patients (FED = 250 and HBED = 250). Patients did not differ by age, gender, or BMI. FED patients were more likely to be white (89.6% vs. 70.8%, p < 0.001) and have higher Charlson Co-morbidity Index scores (3.5 vs. 2.4, p < 0.001). Average LOS for FED patients was 5 days, compared to 7 days for HBED patients (p < 0.001). After adjusting for demographic and clinical confounders, there was significant correlation between ED facility type and LOS in hospital (p < 0.001).
CONCLUSION
Patients transferred from FEDs to an ICU were similar in age and gender, but more likely to be white with a higher Charlson Comorbidity Index score. FED patients experienced shorter hospital length of stay compared to patients admitted from a HBED.
背景
独立急诊部（FED）24/7/365 全天候为所有患者提供服务，包括危重症患者。我们对从三级医院转入重症监护病房（ICU）的三家 FED 患者进行了特征描述，并比较了从 FED 转入 ICU 与从医院急诊部（HBED）转入 ICU 的患者的住院时间（LOS）。
方法
我们进行了一项回顾性观察队列研究，时间为 2014 年 1 月至 2016 年 12 月。采用卡方检验和 Fisher 确切检验比较 FED 和 HBED 患者的人口统计学和临床资料，采用 Student's t 检验比较连续变量。主要观察终点为住院 LOS。多变量线性回归用于估计 LOS 与急诊设施类型之间的关联，同时调整潜在混杂因素。
结果
我们纳入了 500 例危重症患者（FED=250 例，HBED=250 例）。患者在年龄、性别或 BMI 方面无差异。FED 患者更可能为白人（89.6% vs. 70.8%，p<0.001），Charlson 合并症指数评分更高（3.5 vs. 2.4，p<0.001）。FED 患者的平均 LOS 为 5 天，HBED 患者为 7 天（p<0.001）。调整人口统计学和临床混杂因素后，ED 设施类型与住院 LOS 之间存在显著相关性（p<0.001）。
结论
从 FED 转入 ICU 的患者在年龄和性别方面相似，但更可能为白人，Charlson 合并症指数评分更高。与从 HBED 转入 ICU 的患者相比，FED 患者的住院时间更短。
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