Dalton Michael K, Andriotti Tomas, Matsas Bridget, Chaudhary Muhammad Ali, Tilley Laura, Lipsitz Stuart, Learn Peter A, Schoenfeld Andrew J, Jarman Molly P, Goralnick Eric
Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA 02120, USA.
Harvard Medical School, Boston, MA 02115, USA.
Mil Med. 2021 May 3;186(5-6):606-612. doi: 10.1093/milmed/usaa547.
Emergency department (ED) utilization represents an expensive and growing means of accessing care for a variety of conditions. Prior studies have characterized ED utilization in the general population. We aim to identify the clinical conditions that drive ED utilization in a universally insured population and the impacts of care setting on ED use and admissions in the U.S. Military Health System.
We queried TRICARE claims data from October 1, 2012, to September 30, 2015, to identify all ED visits for adult patients (age 18-64). The primary presenting diagnoses of all ED visits and those leading to admission are presented with descriptive statistics. Logistic regression was used to identify clinical and sociodemographic factors associated with admission from the ED.
A total of 4,687,205 ED visits were identified, of which 46% took place in the DoD healthcare facilities (direct care). The most common diagnoses across all ED visits were abdominal pain, chest pain, headache, nausea and vomiting, and urinary tract infection. A total of 270,127 (5.8%) ED visits led to inpatient admission. The most common diagnoses leading to admission were chest pain, abdominal pain, depression, conditions relating to acute psychological stress, and pneumonia. For patients presenting with 1 of the 10 most common ED diagnoses, those who were seen at a civilian ED were significantly less likely to be admitted (3.4%) compared to direct care facilities (4.1%) in an adjusted logistic regression model (Adjusted Odds Ratio 0.40 [95% CI: 0.40-0.41], P < .001).
Ultimately, we show that abdominal pain and chest pain are the most common reasons for presentation to the ED in the Military Health System and the most common presenting diagnoses for admission from the ED. Among patients presenting with the most common ED conditions, direct care EDs were significantly more likely to admit patients than civilian facilities.
急诊科（ED）的利用是一种昂贵且呈增长趋势的获取各种疾病治疗的方式。先前的研究已对普通人群中急诊科的利用情况进行了描述。我们旨在确定在美国军事医疗系统中推动全民参保人群利用急诊科的临床病症，以及护理环境对急诊科使用和住院情况的影响。
我们查询了2012年10月1日至2015年9月30日的TRICARE索赔数据，以确定所有成年患者（年龄18 - 64岁）的急诊科就诊情况。对所有急诊科就诊以及导致住院的主要诊断进行描述性统计。使用逻辑回归来确定与从急诊科住院相关的临床和社会人口统计学因素。
共识别出4,687,205次急诊科就诊，其中46%发生在国防部医疗设施（直接护理）。所有急诊科就诊中最常见的诊断是腹痛、胸痛、头痛、恶心和呕吐以及尿路感染。共有270,127次（5.8%）急诊科就诊导致住院。导致住院的最常见诊断是胸痛、腹痛、抑郁症、与急性心理压力相关的病症以及肺炎。在出现10种最常见急诊科诊断之一的患者中，在调整后的逻辑回归模型中，与直接护理设施（4.1%）相比，在民用急诊科就诊的患者住院可能性显著降低（3.4%）（调整后的优势比0.40 [95%置信区间：0.40 - 0.41]，P <.001）。
最终，我们表明腹痛和胸痛是军事医疗系统中前往急诊科就诊的最常见原因，也是从急诊科住院的最常见诊断。在出现最常见急诊科病症的患者中，直接护理的急诊科比民用设施更有可能收治患者。
