Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland; The R. Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, Baltimore, Maryland.
The R. Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, Baltimore, Maryland; Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
J Emerg Med. 2020 Feb;58(2):280-289. doi: 10.1016/j.jemermed.2019.09.041. Epub 2019 Nov 22.
Transfer delays of critically ill patients from other hospitals' emergency departments (EDs) to an appropriate referral hospital's intensive care unit (ICU) are associated with poor outcomes.
We hypothesized that an innovative Critical Care Resuscitation Unit (CCRU) would be associated with improved outcomes by reducing transfer times to a quaternary care center and times to interventions for ED patients with critical illnesses.
This pre-post analysis compared 3 groups of patients: a CCRU group (patients transferred to the CCRU during its first year [July 2013 to June 2014]), a 2011-Control group (patients transferred to any ICU between July 2011 and June 2012), and a 2013-Control group (patients transferred to other ICUs between July 2013 and June 2014). The primary outcome was time from transfer request to ICU arrival. Secondary outcomes were the interval between ICU arrival to the operating room and in-hospital mortality.
We analyzed 1565 patients (644 in the CCRU, 574 in the 2011-Control, and 347 in 2013-Control groups). The median time from transfer request to ICU arrival for CCRU patients was 108 min (interquartile range [IQR] 74-166 min) compared with 158 min (IQR 111-252 min) for the 2011-Control and 185 min (IQR 122-283 min) for the 2013-Control groups (p < 0.01). The median arrival-to-urgent operation for the CCRU group was 220 min (IQR 120-429 min) versus 439 min (IQR 290-645 min) and 356 min (IQR 268-575 min; p < 0.026) for the 2011-Control and 2013-Control groups, respectively. After adjustment with clinical factors, transfer to the CCRU was associated with lower mortality (odds ratio 0.64 [95% confidence interval 0.44-0.93], p = 0.019) in multivariable logistic regression.
The CCRU, which decreased time from outside ED's transfer request to referral ICU arrival, was associated with lower mortality likelihood. Resuscitation units analogous to the CCRU, which transfer resource-intensive patients from EDs faster, may improve patient outcomes.
从其他医院急诊科（ED）转至合适转诊医院重症监护病房（ICU）的危重症患者存在转院时间延迟的情况，而这与不良预后相关。
我们假设，创新的重症急救复苏单元（CCRU）可以通过缩短向四级医疗中心的转院时间和危重症 ED 患者接受干预的时间，改善转院预后。
本项前后对照研究比较了三组患者：CCRU 组（在 CCRU 成立的第一年[2013 年 7 月至 2014 年 6 月]转至 CCRU 的患者）、2011 年对照组（2011 年 7 月至 2012 年 6 月期间转至任何 ICU 的患者）和 2013 年对照组（2013 年 7 月至 2014 年 6 月期间转至其他 ICU 的患者）。主要转院预后是从转院申请到 ICU 到达的时间。次要转院预后是从 ICU 到达到进入手术室的时间间隔和院内死亡率。
我们分析了 1565 例患者（CCRU 组 644 例，2011 年对照组 574 例，2013 年对照组 347 例）。CCRU 组患者从转院申请到 ICU 到达的中位时间为 108 分钟（四分位距 [IQR] 74-166 分钟），而 2011 年对照组为 158 分钟（IQR 111-252 分钟），2013 年对照组为 185 分钟（IQR 122-283 分钟）（p<0.01）。CCRU 组从到达 ICU 到紧急手术的中位时间为 220 分钟（IQR 120-429 分钟），而 2011 年对照组为 439 分钟（IQR 290-645 分钟），2013 年对照组为 356 分钟（IQR 268-575 分钟；p<0.026）。在经过临床因素调整后，多变量逻辑回归分析显示，转至 CCRU 与较低的死亡率相关（比值比 0.64 [95%置信区间 0.44-0.93]，p=0.019）。
CCRU 可缩短 ED 外转院请求到转诊 ICU 到达的时间，与较低的死亡率可能性相关。类似于 CCRU 的复苏单元可加快将资源密集型患者从 ED 转移，可能会改善患者预后。
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