Adler David, Abar Beau, Durham Danielle D, Bastani Aveh, Bernstein Steven L, Baugh Christopher W, Bischof Jason J, Coyne Christopher J, Grudzen Corita R, Henning Daniel J, Hudson Matthew F, Klotz Adam, Lyman Gary H, Madsen Troy E, Pallin Daniel J, Reyes-Gibby Cielito C, Rico Juan Felipe, Ryan Richard J, Shapiro Nathan I, Swor Robert, Thomas Charles R, Venkat Arvind, Wilson Jason, Yeung Sai-Ching Jim, Caterino Jeffrey M
Department of Emergency Medicine, University of Rochester, Rochester, New York.
Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland.
J Emerg Med. 2019 Sep;57(3):354-361. doi: 10.1016/j.jemermed.2019.05.023. Epub 2019 Jul 26.
Patients with active cancer account for a growing percentage of all emergency department (ED) visits and have a unique set of risks related to their disease and its treatments. Effective triage for this population is fundamental to facilitating their emergency care.
We evaluated the validity of the Emergency Severity Index (ESI; version 4) triage tool to predict ED-relevant outcomes among adult patients with active cancer.
We conducted a prespecified analysis of the observational cohort established by the National Cancer Institute-supported Comprehensive Oncologic Emergencies Research Network's multicenter (18 sites) study of ED visits by patients with active cancer (N = 1075). We used a series of χ tests for independence to relate ESI scores with 1) disposition, 2) ED resource use, 3) hospital length of stay, and 4) 30-day mortality.
Among the 1008 subjects included in this analysis, the ESI distribution skewed heavily toward high acuity (>95% of subjects had an ESI level of 1, 2, or 3). ESI was significantly associated with patient disposition and ED resource use (p values < 0.05). No significant associations were observed between ESI and the non-ED based outcomes of hospital length of stay or 30-day mortality.
ESI scores among ED patients with active cancer indicate higher acuity than the general ED population and are predictive of disposition and ED resource use. These findings show that the ESI is a valid triage tool for use in this population for outcomes directly relevant to ED care.
患有活动性癌症的患者在所有急诊科就诊患者中所占比例日益增加，并且因其疾病及其治疗存在一系列独特风险。对这一人群进行有效的分诊对于促进其急诊护理至关重要。
我们评估了急诊严重程度指数（ESI；第4版）分诊工具预测成年活动性癌症患者急诊相关结局的有效性。
我们对由美国国立癌症研究所支持的综合肿瘤急症研究网络的多中心（18个地点）活动性癌症患者急诊就诊研究（N = 1075）建立的观察性队列进行了预先指定的分析。我们使用一系列独立性χ检验将ESI评分与以下因素相关联：1）处置方式，2）急诊资源使用情况，3）住院时间，4）30天死亡率。
在纳入该分析的1008名受试者中，ESI分布严重偏向高急症（>95% 的受试者ESI水平为1、2或3）。ESI与患者处置方式和急诊资源使用情况显著相关（p值<0.05）。未观察到ESI与基于非急诊的住院时间或30天死亡率结局之间存在显著关联。
急诊活动性癌症患者的ESI评分表明其急症程度高于普通急诊人群，并且可预测处置方式和急诊资源使用情况。这些发现表明，ESI是用于这一人群的有效分诊工具，可用于与急诊护理直接相关的结局。
