Gupta Arjun K, Savu Anamaria, Sheldon Robert S, Raj Satish, Kaul Padma, Sandhu Roopinder K
Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada.
Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
CJC Open. 2019 Apr 12;1(3):141-146. doi: 10.1016/j.cjco.2019.03.006. eCollection 2019 May.
Ambulance use is a costly mode of transportation to the emergency department (ED). Syncope is a frequent presentation to the ED; however, no data exist regarding the proportion of hospitalized patients with syncope arriving by ambulance and their outcomes compared with self-presenters.
The Canadian Institute for Health Information database was used to identify patients aged > 20 years hospitalized with a primary diagnosis of syncope (International Classification of Diseases 10th Revision code R55) in Canada, except Quebec, between April 2004 and March 2016. Logistic regression models (odds ratio and 95% confidence interval) were used to identify demographics, clinical factors, and province associated with ambulance use and whether ambulance use was associated with in-hospital mortality.
Among 108,967 syncope hospitalizations, 64% of patients arrived by ambulance, and use increased from 58.8% to 66.1% over 12 years ( for trend < 0.01). Significant variations existed in ambulance use across provinces ( < 0.01). Predictors associated with higher odds of ambulance use were increasing age, male sex, urban residence, residing in areas with lower annual household income, and higher comorbidity burden. In multivariable-adjusted analysis, ambulance use was associated with a 1.7-fold higher odds of in-hospital mortality.
Approximately two-thirds of patients hospitalized for syncope presented by ambulance, and use has increased over time. Hospitalized patients in syncope who are transported by ambulance have a worse prognosis. Further research on emergency medical services' risk stratification of patients who are transported by ambulance may help to identify a low-risk population who may obviate the need for transport.
使用救护车是前往急诊科（ED）成本较高的一种交通方式。晕厥是急诊科常见的就诊原因；然而，尚无关于因晕厥住院的患者通过救护车就诊的比例及其与自行就诊者相比的结局的数据。
利用加拿大卫生信息研究所数据库，识别2004年4月至2016年3月期间加拿大除魁北克省外，以晕厥作为主要诊断（国际疾病分类第10版编码R55）住院的20岁以上患者。采用逻辑回归模型（比值比和95%置信区间）来确定与使用救护车相关的人口统计学、临床因素和省份，以及使用救护车是否与院内死亡率相关。
在108,967例晕厥住院病例中，64%的患者通过救护车就诊，且在12年期间使用率从58.8%增至66.1%（趋势P<0.01）。各省之间救护车使用情况存在显著差异（P<0.01）。与使用救护车几率较高相关的预测因素包括年龄增加、男性、城市居住、居住在家庭年收入较低地区以及合并症负担较重。在多变量调整分析中，使用救护车与院内死亡率高出1.7倍的几率相关。
因晕厥住院的患者中约三分之二通过救护车就诊，且随着时间推移使用率有所增加。通过救护车转运的晕厥住院患者预后较差。对通过救护车转运的患者进行紧急医疗服务风险分层的进一步研究，可能有助于识别出无需转运的低风险人群。
