Lin Chun-Fu, Huang Yi-Syun, Tsai Ming-Ta, Wu Kuan-Han, Lin Chien-Fu, Chiu I-Min
Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Rd. Niaosong Dist., Kaohsiung 83301, Taiwan.
Department of Computer Science and Engineering, National Sun Yet-Sen University, Kaohsiung 804, Taiwan.
Healthcare (Basel). 2021 Apr 7;9(4):431. doi: 10.3390/healthcare9040431.
Intensive care unit (ICU) admission following a short-term emergency department (ED) revisit has been considered a particularly undesirable outcome among return-visit patients, although their in-hospital prognosis has not been discussed. We aimed to compare clinical outcomes between adult patients admitted to the ICU after unscheduled ED revisits and those admitted during index ED visits.
This retrospective study was conducted at two tertiary medical centers in Taiwan from 1 January 2016 to 31 December 2017. All adult non-trauma patients admitted to the ICU directly via the ED during the study period were included and divided into two comparison groups: patients admitted to the ICU during index ED visits and those admitted to the ICU during return ED visits. The outcomes of interest included in-hospital mortality, mechanical ventilation (MV) support, profound shock, hospital length of stay (HLOS), and total medical cost.
Altogether, 12,075 patients with a mean (standard deviation) age of 64.6 (15.7) years were included. Among these, 5.3% were admitted to the ICU following a return ED visit within 14 days and 3.1% were admitted following a return ED visit within 7 days. After adjusting for confounding factors for multivariate regression analysis, ICU admission following an ED revisit within 14 days was not associated with an increased mortality rate (adjusted odds ratio (aOR): 1.08, 95% confidence interval (CI): 0.89 to 1.32), MV support (aOR: 1.06, 95% CI: 0.89 to 1.26), profound shock (aOR: 0.99, 95% CI: 0.84 to 1.18), prolonged HLOS (difference: 0.04 days, 95% CI: -1.02 to 1.09), and increased total medical cost (difference: USD 361, 95% CI: -303 to 1025). Similar results were observed after the regression analysis in patients that had a 7-day return visit.
ICU admission following a return ED visit was not associated with major in-hospital outcomes including mortality, MV support, shock, increased HLOS, or medical cost. Although ICU admissions following ED revisits are considered serious adverse events, they may not indicate poor prognosis in ED practice.
短期急诊科（ED）复诊后入住重症监护病房（ICU）被认为是复诊患者中特别不理想的结局，尽管尚未讨论过他们的院内预后情况。我们旨在比较计划外ED复诊后入住ICU的成年患者与初次ED就诊时入住ICU的成年患者的临床结局。
本回顾性研究于2016年1月1日至2017年12月31日在台湾的两家三级医疗中心进行。纳入研究期间直接通过ED入住ICU的所有成年非创伤患者，并将其分为两个比较组：初次ED就诊时入住ICU的患者和复诊ED就诊时入住ICU的患者。感兴趣的结局包括院内死亡率、机械通气（MV）支持、严重休克、住院时间（HLOS）和总医疗费用。
共纳入12,075例患者，平均（标准差）年龄为64.6（15.7）岁。其中，5.3%在14天内复诊ED后入住ICU，3.1%在7天内复诊ED后入住ICU。在对多因素回归分析的混杂因素进行调整后，14天内ED复诊后入住ICU与死亡率增加（调整后的优势比（aOR）：1.08，95%置信区间（CI）：0.89至1.32）、MV支持（aOR：1.06，95%CI：0.89至1.26）严重休克（aOR：0.99，95%CI：0.84至1.18）、HLOS延长（差异：0.04天，95%CI：-1.02至1.09）以及总医疗费用增加（差异：361美元，95%CI：-303至1025）均无关。在对7天复诊患者进行回归分析后也观察到了类似结果。
复诊ED后入住ICU与包括死亡率、MV支持、休克HLOS延长或医疗费用增加在内的主要院内结局无关。尽管ED复诊后入住ICU被认为是严重不良事件，但在ED实践中它们可能并不表明预后不良。
