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非特异性腹痛患者早期返回急诊科的危险因素及计算机断层扫描的应用

Risk Factors for Early Return Visits to the Emergency Department in Patients Presenting with Nonspecific Abdominal Pain and the Use of Computed Tomography Scan.

作者信息

Yau Fei-Fei Flora, Yang Ying, Cheng Chi-Yung, Li Chao-Jui, Wang Su-Hung, Chiu I-Min

机构信息

Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan.

Department of Computer Science and Engineering, National Sun Yat-Sen University, Kaohsiung 804, Taiwan.

出版信息

Healthcare (Basel). 2021 Oct 30;9(11):1470. doi: 10.3390/healthcare9111470.

Abstract

Over a quarter of patients presenting with abdominal pain at emergency departments (EDs) are diagnosed with nonspecific abdominal pain (NSAP) at discharge. This study investigated the risk factors associated with return ED visits in Taiwanese patients with NSAP after discharge. We divided patients into two groups: the study group comprising patients with ED revisits after the index ED visit, and the control group comprising patients without revisits. During the study period, 10,341 patients discharged with the impression of NSAP after ED management. A regression analysis found that older age (OR [95%CI]: 1.007 [1.003-1.011], = 0.004), male sex (OR [95%CI]: 1.307 [1.036-1.650], = 0.024), and use of NSAIDs (OR [95%CI]: 1.563 [1.219-2.003], < 0.001) and opioids (OR [95%CI]: 2.213 [1.643-2.930], < 0.001) during the index visit were associated with increased return ED visits. Computed tomography (CT) scans (OR [95%CI]: 0.605 [0.390-0.937], = 0.021) were associated with decreased ED returns, especially for those who were older than 60, who had an underlying disease, or who required pain control during the index ED visit.

摘要

超过四分之一在急诊科(ED)因腹痛就诊的患者在出院时被诊断为非特异性腹痛(NSAP)。本研究调查了台湾NSAP患者出院后再次到急诊科就诊的相关危险因素。我们将患者分为两组:研究组包括在首次ED就诊后再次到ED就诊的患者,对照组包括未再次就诊的患者。在研究期间,10341例患者在ED处理后以NSAP诊断出院。回归分析发现,年龄较大(OR[95%CI]:1.007[1.003 - 1.011],P = 0.004)、男性(OR[95%CI]:1.307[1.036 - 1.650],P = 0.024),以及在首次就诊时使用非甾体抗炎药(NSAIDs)(OR[95%CI]:1.563[1.219 - 2.003],P < 0.001)和阿片类药物(OR[95%CI]:2.213[1.643 - 2.930],P < 0.001)与再次到ED就诊的增加有关。计算机断层扫描(CT)(OR[95%CI]:0.605[0.390 - 0.937],P = 0.021)与ED复诊减少有关,特别是对于那些年龄大于60岁、有基础疾病或在首次ED就诊时需要疼痛控制的患者。

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