Jang Dong-Hyun, Lee Dong Keon, Shin Jonghwan, Jo You Hwan, Park Seung Min
Department of Emergency Medicine, Korea University Anam Hospital, Seoul, Republic of Korea.
Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Am J Emerg Med. 2021 Nov;49:124-129. doi: 10.1016/j.ajem.2021.05.072. Epub 2021 Jun 1.
Several studies have previously reported that a prolonged emergency department length of stay (EDLOS) is associated with poor outcomes in critically ill patients. This study was performed to investigate the relationship between the EDLOS and the neurologic outcome at 28 days in out-of-hospital cardiac arrest (OHCA) patients.
We conducted a retrospective analysis of prospectively collected data from OHCA patients who achieved the return of spontaneous circulation (ROSC) in the EDs of three urban tertiary teaching hospitals from December 2013 to October 2020. Patients were divided into four groups according to the EDLOS, according to the quartile distribution: EDLOS <107 min, EDLOS 107-176 min, EDLOS 176-275 min, and EDLOS ≥275 min. Comparisons of outcomes among the groups and multivariable logistic regression analysis were performed.
A total of 807 patients were included in the analysis. The proportions of patients with a good neurologic outcome at 28 days in the groups with EDLOS <107 min, EDLOS 107-176 min, EDLOS 176-275 min, and EDLOS ≥275 min were 37.0%, 29.8%, 26.9, and 20.4%, respectively (p < 0.001). In the multivariable analysis, the odds ratios for a poor neurologic outcome at 28 days in the groups with EDLOS 107-176 min, EDLOS 176-275 min, and EDLOS ≥275 min compared with the group with EDLOS <107 min were 1.19 (95% CI, 0.67-2.13), 1.73 (95% CI, 0.95-3.21), and 1.91 (95% CI, 1.03-3.57), respectively.
An EDLOS longer than 275 min after the ROSC was independently associated with a poor neurologic outcome at 28 days.
此前多项研究报告称，急诊科住院时间延长（EDLOS）与危重症患者的不良预后相关。本研究旨在调查院外心脏骤停（OHCA）患者的EDLOS与28天时神经功能预后之间的关系。
我们对2013年12月至2020年10月在三家城市三级教学医院急诊科实现自主循环恢复（ROSC）的OHCA患者前瞻性收集的数据进行了回顾性分析。根据EDLOS的四分位数分布，将患者分为四组：EDLOS<107分钟、EDLOS 107 - 176分钟、EDLOS 176 - 275分钟和EDLOS≥275分钟。对各组的预后进行比较并进行多变量逻辑回归分析。
共有807例患者纳入分析。EDLOS<107分钟、EDLOS 107 - 176分钟、EDLOS 176 - 275分钟和EDLOS≥275分钟组28天时神经功能预后良好的患者比例分别为37.0%、29.8%、26.9%和20.4%（p<0.001）。在多变量分析中，与EDLOS<107分钟组相比，EDLOS 107 - 176分钟、EDLOS 176 - 275分钟和EDLOS≥275分钟组28天时神经功能预后不良的比值比分别为1.19（95%CI，0.67 - 2.13）、1.73（95%CI，0.95 - 3.21）和1.91（95%CI，1.03 - 3.57）。
ROSC后EDLOS超过275分钟与28天时不良神经功能预后独立相关。
