Craen Alexandra, Mangal Rohan, Stead Tej G, Ganti Latha
Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA.
Emergency Medicine, Johns Hopkins University, Baltimore, USA.
Cureus. 2019 Oct 1;11(10):e5818. doi: 10.7759/cureus.5818.
Background Nontraumatic intracranial hemorrhages (ICH) are serious cerebrovascular events with high morbidity and mortality. They occur in about two million people a year worldwide. While ICH continues to be a focus of research in the medical community, there is little data on the differences in outcomes by gender. We aimed to further investigate these differences in our study. Methods This analysis involves a de-identified dataset of all adult patients who presented to one of our hospital system's emergency departments with ICHs as one of the top three discharge diagnoses. This study was considered exempt by our medical school's Institutional Review Board (IRB). Our hospital system comprises over 176 hospitals in the United States with over 8.6 million emergency department visits annually. Logistic regression analyses were performed using JMP 14.1. Outcome variables included the length of stay, mortality, and disposition. Results The cohort (n = 8069) comprised 68% Caucasians, 17% Blacks, 5% Asians, and 1% Hispanic. Forty-eight percent of patients were females with a median age of 71 years. Fifty-two percent of patients were males with a median age of 65 years. One-fifth of the cohort (20%) died while another fifth (21%) were discharged home. Thirteen percent joined hospice. Women were significantly more likely to die or join hospice ( <0.0001, OR 1.304, 95% CI: 1.183-1.440) even after controlling for age. Women also had a significantly shorter length of stay even when controlled for age ( = 0.0002, 95% CI: -1.58 to -0.489, = 1.5%) with a median of four days for men and three days for women. Conclusion The median age for women with nontraumatic ICH is older than men, which could explain their increased rates of mortality and discharge to hospice. However, even after controlling for age, women were significantly more likely to die or be discharged to hospice. Conversely, men and younger patients had a longer hospital stay and a higher likelihood of being discharged home.
非创伤性颅内出血(ICH)是严重的脑血管事件,发病率和死亡率都很高。全球每年约有200万人发生ICH。虽然ICH仍然是医学界研究的重点,但关于性别对预后影响差异的数据却很少。我们旨在通过本研究进一步调查这些差异。
本分析涉及一个经过去识别处理的数据集,该数据集包含所有以ICH作为三大出院诊断之一就诊于我院系统急诊科的成年患者。本研究被我校医学院机构审查委员会(IRB)认定为豁免研究。我们的医院系统在美国包括176多家医院,每年急诊科就诊人次超过860万。使用JMP 14.软件进行逻辑回归分析。结局变量包括住院时间、死亡率和出院去向。
该队列(n = 8069)中,68%为白种人,17%为黑人,5%为亚洲人,1%为西班牙裔。48%的患者为女性,中位年龄为71岁。52%的患者为男性,中位年龄为65岁。该队列中有五分之一(20%)的患者死亡,另有五分之一(21%)的患者出院回家。13%的患者进入临终关怀机构。即使在控制年龄因素后,女性死亡或进入临终关怀机构的可能性仍显著更高(P <0.0001,OR 1.304,95% CI:1.183 - 1.440)。即使在控制年龄因素后,女性的住院时间也显著更短(P = 0.0002,95% CI: - 1.58至 - 0.489,效应量 = 1.5%),男性的中位住院时间为4天,女性为3天。
非创伤性ICH女性患者的中位年龄高于男性,这可能解释了她们死亡率增加和出院进入临终关怀机构的比例较高的原因。然而,即使在控制年龄因素后,女性死亡或出院进入临终关怀机构的可能性仍显著更高。相反,男性和年轻患者的住院时间更长,出院回家的可能性更高。