Emergency Department, Division of Emergencies and Critical Care, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, 0318 Oslo, Norway.
Department of Forensic Sciences, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway; Institute of Health and Society, University of Oslo, Postboks 1130 Blindern, 0318 Oslo, Norway.
Int Emerg Nurs. 2021 Jan;54:100939. doi: 10.1016/j.ienj.2020.100939. Epub 2020 Dec 7.
Critically ill general medical patients are an increasing group in the Emergency Department (ED). This register-based cohort study aimed to examine these patients' characteristics, ED management and outcome, and investigate factors associated with ICU admission.
The study comprised all adult medical triage 1 patients treated by a specialized multidisciplinary team in 2015 and 2016. Univariate and multivariate analysis were used.
1294 patients were included. Mean age was 59 years, 56% (n = 725) were male, mean National Early Warning Score 2 (NEWS2) was 7, intensive care unit (ICU) admission was 56.8% (n = 735) and mortality rate was 16.8% (n = 217). Median ED length of stay (LOS) was 1.6 h, 1.2 h if admitted to ICU. The most frequent discharge diagnosis was acute poisoning (24.0%, n = 308). Younger age, male gender, arriving at nighttime weekdays, higher NEWS2 at arrival, critical care interventions or medications in the ED was associated with ICU admission.
More than half of the patients were admitted to ICU, and the mortality rate was 16.8%. A large proportion was diagnosed with acute poisoning. Younger age, higher NEWS and critical care in ED were associated with ICU admission. The short ED LOS suggests that management by a multidisciplinary team is beneficial.
危重症内科患者在急诊科（ED）的比例逐渐增加。本基于注册的队列研究旨在探讨这些患者的特征、ED 管理和预后，并分析与 ICU 收治相关的因素。
本研究纳入了 2015 年和 2016 年由多学科专业团队治疗的所有成年内科分诊 1 患者。采用单变量和多变量分析。
共纳入 1294 例患者。平均年龄为 59 岁，56%（n=725）为男性，平均国家早期预警评分 2（NEWS2）为 7，重症监护病房（ICU）收治率为 56.8%（n=735），死亡率为 16.8%（n=217）。ED 住院时间中位数为 1.6 小时，如果收治 ICU 则为 1.2 小时。最常见的出院诊断是急性中毒（24.0%，n=308）。年龄较小、男性、夜间工作日就诊、入院时 NEWS2 较高、ED 接受重症监护干预或药物治疗与 ICU 收治相关。
超过一半的患者收治 ICU，死亡率为 16.8%。很大一部分被诊断为急性中毒。年龄较小、NEWS 较高和 ED 中的重症监护与 ICU 收治相关。ED 住院时间短表明多学科团队的管理是有益的。
