65岁及以上患者在救护车分配期间的处置情况，包括与未送往医院相关的因素：一项纵向比较研究。
Patients' aged ≥65 years dispositions during ambulance assignments, including factors associated with non-conveyance to hospital: a longitudinal and comparative study.
作者信息
Forsgärde Elin-Sofie, Elmqvist Carina, Fridlund Bengt, Svensson Anders, Andersson Richard, Rööst Mattias
机构信息
Health and Caring Science, Linnaeus University Faculty of Health and Life Sciences, Växjö, Sweden
Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University Faculty of Health and Life Sciences, Växjö, Sweden.
出版信息
BMJ Open. 2020 Nov 26;10(11):e038885. doi: 10.1136/bmjopen-2020-038885.
OBJECTIVES
Patients ≥65 years old represent 30%-50% of all ambulance assignments (AAs), and the knowledge of which care level they are disposed to is limited and diverging. The aim of this study was therefore to describe and compare characteristics of patients' aged ≥65 years dispositions during AA, including determining changes over time and factors associated with non-conveyance to hospitals.
DESIGN
A longitudinal and comparative database study.
SETTING
Ambulance service in a Swedish region.
PARTICIPANTS
32 085 AAs with patients ≥65 years old during the years 2014, 2016 and 2018.
EXCLUSION CRITERIA
AAs with interhospital patient transfers and lack of patients' dispositions data.
OUTCOME MEASURES
Dependent factors: conveyance and non-conveyance to hospitals. Independent factors: age, sex, symptom, triage level, scene, time, day and season.
RESULTS
The majority (n=29 060; 90.6%) of patients' dispositions during AA were conveyance to hospitals. In total, the most common symptoms were circulatory (n=4953; 15.5%) and respiratory (n=4529; 14.1%). A significant increase, p<0.01, of non-conveyance to hospitals was shown during 2014 and 2018, from 801 (7.8%) to 1295 (11.4%). Increasing age was associated with decreasing odds of non-conveyance, 85-89 years (OR=0.85, 95 % CI=0.72 to 0.99) and 90 years or older (OR=0.80, 95 % CI=0.68 to 0.93). Several factors were associated with non-conveyance, for example, symptoms of diabetes (OR=8.57, 95 % CI=5.99 to 12.26) and mental disorders (OR=5.71, 95 % CI=3.85 to 8.48) in comparison with infections.
CONCLUSIONS
The study demonstrates several patient characteristics, and factors associated with non-conveyance to hospitals, such as age, symptom, triage level, scene, time, day and season. The increasing non-conveyance trend highlights the importance of further studies on optimal care levels for patients ≥65 years old.
目的
65岁及以上患者占所有救护车任务（AA）的30%-50%，但对于他们适合何种护理级别，人们了解有限且存在分歧。因此，本研究旨在描述和比较65岁及以上患者在救护车任务期间的处置特征，包括确定随时间的变化以及与不送往医院相关的因素。
设计
一项纵向比较数据库研究。
地点
瑞典一个地区的救护车服务。
参与者
2014年、2016年和2018年期间32085例涉及65岁及以上患者的救护车任务。
排除标准
医院间患者转运的救护车任务以及缺乏患者处置数据的情况。
观察指标
因变量：送往医院和未送往医院。自变量：年龄、性别、症状、分诊级别、现场、时间、日期和季节。
结果
在救护车任务期间，大多数患者（n=29060；90.6%）的处置是送往医院。总体而言，最常见的症状是循环系统症状（n=4953；15.5%）和呼吸系统症状（n=4529；14.1%）。2014年至2018年期间，未送往医院的比例显著增加，p<0.01，从801例（7.8%）增至1295例（11.4%）。年龄增加与不送往医院的几率降低相关，85-89岁（OR=0.85，95%CI=0.72至0.99）以及90岁及以上（OR=0.80，95%CI=0.68至0.93）。与感染相比，有几个因素与不送往医院相关，例如糖尿病症状（OR=8.57，95%CI=5.99至12.26）和精神障碍（OR=5.71，95%CI=3.85至8.48）。
结论
该研究展示了若干患者特征以及与不送往医院相关的因素，如年龄、症状、分诊级别、现场、时间、日期和季节。未送往医院的趋势增加凸显了进一步研究65岁及以上患者最佳护理级别的重要性。
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