Rygiel K, Fimmers R, Schacher S, Dormann H, Gräff I
Interdisziplinäres Notfallzentrum, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland.
Institut für Medizinische Biometrie, Informatik und Epidemiologie, Universitätsklinikum Bonn, Bonn, Deutschland.
Med Klin Intensivmed Notfmed. 2020 Apr;115(3):228-236. doi: 10.1007/s00063-019-0595-2. Epub 2019 Jul 30.
Overall, there is only little data in health care research on the subject of emergency care in older patients in Germany. The aim of the present study is to assess the older emergency patient in regard to the core data set "Emergency Department" of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI).
Monocentric, retrospective observational study.
In the observation period, a total of 29,391 emergency patients were treated at the interdisciplinary emergency center. Of these, 8072 emergency patients were ≥65 years old (27.4%). With increasing age, paramedic ambulances (RTW) or physician-led ambulances (NEF) are increasingly used (p < 0.001). Older emergency patients arriving by a physician-led emergency service show a 38.9-fold increase in mortality compared to ambulatory patients (odds ratio = 38.98 [29.22-51.87]). The initial assessment, using the Manchester Triage System (MTS), shows a steady rise towards higher urgency levels with increasing age (p < 0.001). In the multivariate analysis within the individual age clusters, there is a correlation between the triage level and hospital mortality, unrelated to gender (p < 0.001). Likewise the use of consulting physicians can be linked to advanced age (p < 0.001). Also the length of stay in the interdisciplinary emergency center correlates highly with age (p < 0.001).
The older emergency patient clearly differs from younger emergency patients in all key performance indicators considered and already poses a special challenge to emergency departments.
总体而言，德国医疗保健研究中关于老年患者急诊护理这一主题的数据非常少。本研究的目的是根据德国重症监护与急诊医学跨学科协会（DIVI）的核心数据集“急诊科”对老年急诊患者进行评估。
单中心回顾性观察研究。
在观察期内，跨学科急诊中心共治疗了29391例急诊患者。其中，8072例急诊患者年龄≥65岁（27.4%）。随着年龄增长，越来越多地使用护理人员救护车（RTW）或医生主导的救护车（NEF）（p<0.001）。与非卧床患者相比，由医生主导的急救服务送来的老年急诊患者死亡率增加了38.9倍（优势比=38.98[29.22 - 51.87]）。使用曼彻斯特分诊系统（MTS）进行的初始评估显示，随着年龄增长，向更高紧急程度的趋势稳步上升（p<0.001）。在各个年龄组的多变量分析中，分诊级别与医院死亡率之间存在相关性，与性别无关（p<0.001）。同样，会诊医生的使用也与高龄有关（p<0.001）。此外，在跨学科急诊中心的住院时间也与年龄高度相关（p<0.001）。
在所有考虑的关键绩效指标方面，老年急诊患者与年轻急诊患者明显不同，已经给急诊科带来了特殊挑战。
