Liu Sung-Wei
Department of Emergency, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.
Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
Tzu Chi Med J. 2020 Dec 24;33(2):169-174. doi: 10.4103/tcmj.tcmj_155_20. eCollection 2021 Apr-Jun.
Return visit to emergency department (ED) is a common phenomenon and has been a clinical indicator of quality of care in ED. Most of previous articles focused on the characteristics of the patients returning within 72 h after ED discharge, while those on subsequent admission are numbered. This study's purpose is to identify risk factors for admission among 72-h return visit in the ED adult population.
This retrospective cohort study was conducted at a medical center in Eastern Taiwan. The study period was from January 1, 2013, to December 31, 2013. We excluded patients who left against medical advice or without being seen, who was admitted or transferred at the index ED visit, whose medical records were incomplete, and whose age was below 18 years old. Significant variables were selected based on univariate analysis and later entered into multivariate logistic regression analysis to identify risk factors for 72-h return admission.
We identified 1575 eligible visits, and there were 1,119 visits entering into the final analysis. Male gender (odds ratio [OR] = 1.44), ambulance-transport at return visit (OR = 3.68), senior staff (OR = 1.52), work-up (OR = 3.03), and longer length of stay (LOS) were associated with higher risks of admission among ED 72-h return visits. Age, comorbidity, mode of transport at index visit, consultation, triage, type of illness, outpatient department visit between ED visits, and interval between index and return visits were not significantly associated with return admission.
Gender, mode of transportation, staff experience, check-up, and LOS are associated with ED return admission.
急诊复诊是一种常见现象，一直是急诊科医疗质量的临床指标。以往大多数文章关注的是急诊出院后72小时内复诊患者的特征，而关于后续再次入院的文章则较少。本研究旨在确定急诊科成年患者72小时复诊后再次入院的危险因素。
本回顾性队列研究在台湾东部的一家医疗中心进行。研究期间为2013年1月1日至2013年12月31日。我们排除了擅自离院或未就诊、在首次急诊就诊时入院或转院、病历不完整以及年龄低于18岁的患者。基于单因素分析选择显著变量，随后将其纳入多因素逻辑回归分析，以确定72小时复诊后再次入院的危险因素。
我们确定了1575例符合条件的就诊病例，其中1119例纳入最终分析。男性（比值比[OR]=1.44）、复诊时救护车转运（OR=3.68）、高级医护人员（OR=1.52）、检查（OR=3.03）以及住院时间较长与急诊科72小时复诊后再次入院的较高风险相关。年龄、合并症、首次就诊时的交通方式、会诊、分诊、疾病类型、两次急诊就诊之间的门诊就诊情况以及首次就诊与复诊之间的间隔时间与再次入院无显著关联。
性别、交通方式、医护人员经验、检查及住院时间与急诊复诊后再次入院有关。
