Singh Mika, Maharaj Roshen, Allorto Nikki, Wise Robert
Division of Emergency Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
Department of Emergency Medicine, Livingstone Tertiary Hospital, Port Elizabeth, South Africa.
Afr J Emerg Med. 2021 Dec;11(4):471-476. doi: 10.1016/j.afjem.2021.07.006. Epub 2021 Nov 3.
The objective was to describe the clinical characteristics, disease profile and outcome of patients referred from a regional hospital Emergency Centre (EC) to the Intensive Care Unit (ICU).
A retrospective review was performed using data extracted from the Integrated Critical Care Electronic Database (iCED). Data were extracted from the database with respect to patient characteristics, Society of Critical Care Medicine (SCCM) grading, and outcome of the ICU referral. Modified early warning scores (MEWS) were calculated from EC referral data.
There were a total of 2187 referrals. Of these, 56.3% (1231/2187) were male. The mean age of referrals was 36 years. Of the referred patients, 41.5% (907/2187) were initially accepted for admission. A further 378 patients were accepted for admission after a follow up ICU review. Medical conditions accounted for the majority of patient referrals, followed by general surgery and trauma. Most patients initially accepted to ICU were classified as SCCM I and II and had a mean MEWS of 4. Almost half of the patients experienced a delay in admission, most commonly due to a lack of ICU bed availability. ICU mortality was 13.6% for patients admitted from the EC.
The EC population referred to the ICU was young with a high burden of medical and trauma conditions. Decisions to accept patients to ICU are limited by available resources, and there was a need to apply ICU triage criteria. Delays in the transfer of ICU patients from the EC increase the workload and contribute to EC crowding.
目的是描述从地区医院急诊科（EC）转诊至重症监护病房（ICU）的患者的临床特征、疾病概况及转归。
采用从综合重症监护电子数据库（iCED）提取的数据进行回顾性分析。从数据库中提取有关患者特征、危重病医学会（SCCM）分级以及ICU转诊转归的数据。根据EC转诊数据计算改良早期预警评分（MEWS）。
共有2187例转诊患者。其中，56.3%（1231/2187）为男性。转诊患者的平均年龄为36岁。在转诊患者中，41.5%（907/2187）最初被接受入院。在ICU进行后续评估后，又有378例患者被接受入院。内科疾病占患者转诊的大多数，其次是普通外科和创伤。大多数最初被接受入住ICU的患者被归类为SCCM I级和II级，平均MEWS为4分。几乎一半的患者入院延迟，最常见的原因是ICU床位不足。从EC入院的患者ICU死亡率为13.6%。
转诊至ICU的EC患者群体年轻，内科和创伤疾病负担重。接受患者入住ICU的决定受可用资源限制，需要应用ICU分诊标准。ICU患者从EC转诊的延迟增加了工作量并导致EC拥挤。
