Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
Emerg Med J. 2021 Dec;38(12):874-881. doi: 10.1136/emermed-2020-209801. Epub 2021 Mar 3.
While the older population accounts for an increasing proportion of emergency department (ED), little is known about intubation-related adverse events in this high-risk population. We sought to determine whether advanced age is associated with a higher risk of intubation-related adverse events in the ED.
This is an analysis of data from a prospective, 15-centre, observational study-the second Japanese Emergency Airway Network (JEAN-2) study. The current analysis included adult (aged ≥18 years) patients who underwent intubation in the ED between 2012 and 2018. The primary exposure was age (18-39, 40-64, 65-74, 75-84 and ≥85 years). The primary outcome was overall intubation-related adverse events during or immediately after an intubation. Adverse events were further categorised into major (hypotension, hypoxaemia, oesophageal intubation, cardiac arrest, dysrhythmia and death) and minor (endobronchial intubation, oesophageal intubation with early recognition, dental/lip trauma, airway trauma and regurgitation) adverse events. We constructed multivariable logistic regression models adjusting for seven potential confounders with generalised estimating equations that account for patients clustering within the ED.
Among 9714 patients eligible for the analysis, 15% were aged ≥85 years, and 16% had adverse events. In the unadjusted models, advanced age was not significantly associated with the risk of overall adverse events. In the adjusted models, the association was significant (adjusted OR 1.41 in age ≥85 years (95% CI, 1.09 to 1.81) compared with age 18-39 years). Specifically, older patients had a significantly higher risk of major adverse events (adjusted OR in age ≥85 years 2.65 (95% CI, 1.78 to 3.94)), which was driven by the association of advanced age with an increased risk of hypotension (adjusted OR in ≥85 years, 5.69 (95% CI, 3.13 to 10.37)). By contrast, advanced age was not associated with minor adverse events.
Based on the data from a prospective multicentre study, advanced age was associated with higher risks of major adverse events.
虽然老年人口在急诊科（ED）中所占比例不断增加，但对于这一高危人群中与插管相关的不良事件知之甚少。我们旨在确定年龄增长是否与 ED 中与插管相关的不良事件风险增加有关。
这是一项对前瞻性、15 中心、观察性研究——第二次日本急诊气道网络（JEAN-2）研究数据的分析。当前的分析纳入了 2012 年至 2018 年期间在 ED 接受插管的成年（年龄≥18 岁）患者。主要暴露因素为年龄（18-39 岁、40-64 岁、65-74 岁、75-84 岁和≥85 岁）。主要结局是插管期间或之后立即发生的总体插管相关不良事件。不良事件进一步分为主要（低血压、低氧血症、食管插管、心脏骤停、心律失常和死亡）和次要（支气管内插管、早期识别的食管插管、牙齿/唇部创伤、气道创伤和反流）不良事件。我们使用广义估计方程构建了多变量逻辑回归模型，该模型调整了七个潜在混杂因素的影响，这些因素考虑了 ED 内患者的聚类情况。
在 9714 名符合分析条件的患者中，15%的患者年龄≥85 岁，16%的患者发生了不良事件。在未调整的模型中，年龄增长与总体不良事件风险无显著相关性。在调整后的模型中，这种相关性具有统计学意义（与 18-39 岁年龄组相比，年龄≥85 岁患者的调整比值比为 1.41（95%置信区间，1.09 至 1.81））。具体而言，老年患者发生主要不良事件的风险显著增加（年龄≥85 岁患者的调整比值比为 2.65（95%置信区间，1.78 至 3.94）），这主要是由于高龄与低血压风险增加相关（年龄≥85 岁患者的调整比值比为 5.69（95%置信区间，3.13 至 10.37））。相比之下，高龄与次要不良事件无关。
基于前瞻性多中心研究的数据，高龄与主要不良事件风险增加有关。
