Ohbe Hiroyuki, Isogai Shunsuke, Nakajima Mikio, Jo Taisuke, Matsui Hiroki, Fushimi Kiyohide, Yasunaga Hideo
Department of Clinical Epidemiology and Health Economics School of Public Health The University of Tokyo Tokyo Japan.
Department of Health Services Research Graduate School of Medicine The University of Tokyo Tokyo Japan.
Acute Med Surg. 2019 Feb 28;6(2):165-172. doi: 10.1002/ams2.400. eCollection 2019 Apr.
Use of a physician-manned prehospital emergency medical service (EMS) has recently become widespread in Japan. Understanding the epidemiology of critically ill patients is essential for planning national and regional physician-manned prehospital EMS systems. However, current knowledge on patients receiving physician-manned prehospital EMS is sparse. The present study aimed to determine the clinical features of critically ill patients with and without physician-manned prehospital EMS, using a national inpatient database in Japan.
Using the Japanese Diagnosis Procedure Combination inpatient database, we identified all hospitalized patients transported to tertiary emergency centers by physician-manned EMS or EMS without a physician from April 2014 to March 2015. We collected data on patient characteristics, in-hospital mortality, admission diagnoses, advanced life support interventions, and incidence of critical illnesses.
We identified 497,911 hospitalized patients transported to tertiary emergency centers by EMS. Of these, 15,507 (3%) patients were hospitalized by physician-manned EMS. The majority of admission diagnoses in the physician-manned EMS group were classified "diseases of the circulatory system" (45%) and "injury, poisoning and certain other consequences of external causes" (34%). The rates of in-hospital mortality, advanced life support interventions, and critical illnesses in the physician-manned EMS group were 22%, 51%, and 53%, respectively. The median incidences of hospitalized patients by physician-manned EMS, advanced life support interventions, and critical illnesses were 12, 137, and 205 per 100,000 persons per year in facilities with physician-manned EMS, respectively.
Our study indicates that physician-manned EMS is dispatched to a relatively small proportion of critically ill patients in Japan.
配备医生的院前急救医疗服务（EMS）最近在日本已广泛普及。了解重症患者的流行病学情况对于规划全国和地区性配备医生的院前急救医疗服务系统至关重要。然而，目前关于接受配备医生的院前急救医疗服务患者的知识较为匮乏。本研究旨在利用日本的全国住院患者数据库，确定配备医生的院前急救医疗服务组和未配备医生的院前急救医疗服务组重症患者的临床特征。
利用日本诊断程序组合住院患者数据库，我们确定了2014年4月至2015年3月期间由配备医生的急救医疗服务或无医生的急救医疗服务转运至三级急救中心的所有住院患者。我们收集了患者特征、院内死亡率、入院诊断、高级生命支持干预措施以及危重病发病率的数据。
我们确定了497,911名由急救医疗服务转运至三级急救中心的住院患者。其中，15,507名（3%）患者由配备医生的急救医疗服务送医住院。配备医生的急救医疗服务组的大多数入院诊断被归类为“循环系统疾病”（45%）和“损伤、中毒及外部原因的某些其他后果”（34%）。配备医生的急救医疗服务组中的院内死亡率、高级生命支持干预措施使用率和危重病发病率分别为22%、51%和53%。在配备医生的急救医疗服务机构中，配备医生的急救医疗服务送医住院患者、接受高级生命支持干预措施患者和危重病患者的年发病率中位数分别为每10万人12例、137例和205例。
我们的研究表明，在日本，配备医生的急救医疗服务被派送至相对较少比例的重症患者。
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