Department of Internal Medicine, St. James's Hospital, Dublin 8, Ireland.
Clinical Medicine, Trinity College Dublin, Dublin, Ireland.
Ir J Med Sci. 2023 Jun;192(3):1427-1433. doi: 10.1007/s11845-022-03084-w. Epub 2022 Jul 8.
The outcomes of acute medical admissions have been shown to be influenced by a variety of factors including system, patient, societal, and physician-specific differences.
To evaluate the influence of on-call specialty on outcomes in acute medical admissions.
All acute medical admissions to our institution from 2015 to 2020 were evaluated. Admissions were grouped based on admitting specialty. Thirty-day in-hospital mortality and length of stay (LOS) were evaluated. Data was analysed using multivariable logistic regression and truncated Poisson regression modelling.
There were 50,347 admissions in 30,228 patients. The majority of admissions were under Acute Medicine (47.0%), and major medical subspecialties (36.1%); Elderly Care admitted 12.1%. Acute Medicine admissions were older at 72.9 years (IQR 57.0, 82.9) vs. 67.2 years (IQR 50.1, 80.2), had higher Acute Illness Severity (grades 4-6: 85.9% vs. 81.3%; p < 0.001), Charlson Index (> group 0; 61.5% vs. 54.6%; p < 0.001), and Comorbidity Score (40.7% vs. 36.7%; p < 0.001). Over time, there was a small (+ 8%) but significant increase in 30-day in-hospital mortality. Mortality rates for Acute Medicine, major medical specialties, and Elderly Care were not different at 5.1% (95% CI: 4.7, 5.5), 4.7% (95% CI: 4.3, 5.1), and 4.7% (95% CI: 3.9, 5.4), respectively. Elderly Care admissions had shorter LOS (7.8 days (95% CI: 7.6, 8.0)) compared with either Acute Medicine (8.7 days (95% CI: 8.6, 8.8)) or major medical specialties (8.7 days (95% CI: 8.6, 8.9)).
No difference in mortality and minor differences in LOS were observed. The prior pattern of improved outcomes year on year for emergency medical admissions appears ended.
已证实，急性内科住院患者的结局受到多种因素的影响，包括系统、患者、社会和医师特异性差异。
评估值班专科对急性内科住院患者结局的影响。
评估了我院 2015 年至 2020 年期间所有的急性内科住院患者。根据入院科室对患者进行分组。评估 30 天院内死亡率和住院时间（LOS）。使用多变量逻辑回归和截断泊松回归模型进行数据分析。
共纳入 50347 例 30228 名患者。大多数患者入住在急性内科（47.0%）和主要内科亚专科（36.1%），老年科占 12.1%。急性内科患者年龄较大，为 72.9 岁（IQR 57.0，82.9），而其他科室为 67.2 岁（IQR 50.1，80.2），急性疾病严重程度更高（4-6 级：85.9% vs. 81.3%；p<0.001），Charlson 指数（>0 分组：61.5% vs. 54.6%；p<0.001）和合并症评分（40.7% vs. 36.7%；p<0.001）更高。随着时间的推移，30 天院内死亡率有较小但显著的增加（+8%）。急性内科、主要内科专科和老年科的死亡率分别为 5.1%（95%CI：4.7，5.5）、4.7%（95%CI：4.3，5.1）和 4.7%（95%CI：3.9，5.4），无显著差异。老年科的 LOS 更短（7.8 天（95%CI：7.6，8.0）），与急性内科（8.7 天（95%CI：8.6，8.8））或主要内科专科（8.7 天（95%CI：8.6，8.9））相比，差异有统计学意义。
死亡率无差异，LOS 差异较小。急诊内科住院患者的结局逐年改善的模式似乎已经结束。
