Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America.
Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America; Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States of America.
Am J Emerg Med. 2022 Feb;52:64-68. doi: 10.1016/j.ajem.2021.11.038. Epub 2021 Nov 30.
Delays in care for patients with acute cardiac complaints are associated with increased morbidity and mortality. The objective of this study was to quantify rural and urban differences in prehospital time intervals for patients with cardiac complaints.
The ESO Data Collaborative dataset consisting of records from 1332 EMS agencies was queried for 9-1-1 encounters with acute cardiac problems among adults (age ≥ 18) from 1/1/2013-6/1/2018. Location was classified as rural or urban using the 2010 United States Census. The primary outcome was total prehospital time. Generalized estimating equations evaluated differences in the average times between rural and urban encounters while controlling for age, sex, race, transport mode, loaded mileage, and patient stability.
Among 428,054 encounters, the median age was 62 (IQR 50-75) years with 50.7% female, 75.3% white, and 10.3% rural. The median total prehospital, response, scene, and transport times were 37.0 (IQR 29.0-48.0), 6.0 (IQR 4.0-9.0), 16.0 (IQR 12.0-21.0), and 13.0 (IQR 8.0-21.0) minutes. Rural patients had an average total prehospital time that was 16.76 min (95%CI 15.15-18.38) longer than urban patients. After adjusting for covariates, average total time was 5.08 (95%CI 4.37-5.78) minutes longer for rural patients. Average response and transport time were 4.36 (95%CI 3.83-4.89) and 0.62 (95%CI 0.33-0.90) minutes longer for rural patients. Scene time was similar in rural and urban patients (0.09 min, 95%CI -0.15-0.33).
Rural patients with acute cardiac complaints experienced longer prehospital time than urban patients, even after accounting for other key variables, such as loaded mileage.
急性心脏疾病患者的救治延迟与发病率和死亡率的增加有关。本研究的目的是量化农村和城市地区急性心脏疾病患者院前时间间隔的差异。
使用 ESO Data 协作数据集，该数据集包含了 2013 年 1 月 1 日至 2018 年 6 月 1 日期间 1332 个 EMS 机构的记录，查询了成人（年龄≥18 岁）因急性心脏问题拨打 9-1-1 的情况。使用 2010 年美国人口普查数据，将位置分为农村或城市。主要结局指标是总院前时间。使用广义估计方程评估了农村和城市就诊之间平均时间的差异，同时控制了年龄、性别、种族、运输方式、装载里程和患者稳定性。
在 428054 次就诊中，中位数年龄为 62 岁（IQR 50-75 岁），女性占 50.7%，白人占 75.3%，农村占 10.3%。中位数总院前时间、反应时间、现场时间和转运时间分别为 37.0 分钟（IQR 29.0-48.0）、6.0 分钟（IQR 4.0-9.0）、16.0 分钟（IQR 12.0-21.0）和 13.0 分钟（IQR 8.0-21.0）。农村患者的总院前时间平均比城市患者长 16.76 分钟（95%CI 15.15-18.38）。调整协变量后，农村患者的平均总时间长 5.08 分钟（95%CI 4.37-5.78）。农村患者的反应时间和转运时间分别长 4.36 分钟（95%CI 3.83-4.89）和 0.62 分钟（95%CI 0.33-0.90）。农村和城市患者的现场时间相似（0.09 分钟，95%CI -0.15-0.33）。
即使考虑了装载里程等其他关键变量，急性心脏疾病的农村患者的院前时间也比城市患者长。
