Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan City, 333, Taiwan.
Department of Surgery, Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 333, Taiwan.
BMC Psychiatry. 2022 Jul 21;22(1):488. doi: 10.1186/s12888-022-04141-5.
Patients with severe mental illness (SMI) have a shorter life expectancy and have been considered by the World Health Organization (WHO) as a vulnerable group. As the causes for this mortality gap are complex, clarification regarding the contributing factors is crucial to improving the health care of SMI patients. Acute appendicitis is one of the most common indications for emergency surgery worldwide. A higher perforation rate has been found among psychiatric patients. This study aims to evaluate the differences in appendiceal perforation rate, emergency department (ED) management, in-hospital outcomes, and in-hospital expenditure among acute appendicitis patients with or without SMI via the use of a multi-centre database.
Relying on Chang Gung Research Database (CGRD) for data, we selectively used its data from January 1st, 2007 to December 31st, 2017. The diagnoses of acute appendicitis and SMI were confirmed by combining ICD codes with relevant medical records. A non-SMI patient group was matched at the ratio of 1:3 by using the Greedy algorithm. The outcomes were appendiceal perforation rate, ED treatment, in-hospital outcome, and in-hospital expenditure.
A total of 25,766 patients from seven hospitals over a span of 11 years were recruited; among them, 11,513 were excluded by criteria, with 14,253 patients left for analysis. SMI group was older (50.5 vs. 44.4 years, p < 0.01) and had a higher percentage of females (56.5 vs. 44.4%, p = 0.01) and Charlson Comorbidity Index. An analysis of the matched group has revealed that the SMI group has a higher unscheduled 72-hour revisit to ED (17.9 vs. 10.4%, p = 0.01). There was no significant difference in appendiceal perforation rate, ED treatment, in-hospital outcome, and in-hospital expenditure.
Our study demonstrated no obvious differences in appendiceal perforation rate, ED management, in-hospital outcomes, and in-hospital expenditure among SMI and non-SMI patients with acute appendicitis. A higher unscheduled 72-hour ED revisit rate prior to the diagnosis of acute appendicitis in the SMI group was found. ED health providers need to be cautious when it comes to SMI patients with vague symptoms or unspecified abdominal complaints.
患有严重精神疾病（SMI）的患者预期寿命较短，世界卫生组织（WHO）将其视为弱势群体。由于导致这种死亡率差距的原因较为复杂，因此明确促成因素对于改善 SMI 患者的医疗保健至关重要。急性阑尾炎是全球范围内最常见的急症手术指征之一。精神科患者的穿孔率较高。本研究旨在通过使用多中心数据库评估有或没有 SMI 的急性阑尾炎患者的阑尾穿孔率、急诊科（ED）管理、住院结局和住院费用的差异。
我们依靠长庚研究数据库（CGRD）的数据，选择性地使用其 2007 年 1 月 1 日至 2017 年 12 月 31 日的数据。急性阑尾炎和 SMI 的诊断通过结合 ICD 代码和相关病历来确认。使用贪婪算法按 1:3 的比例对非 SMI 患者组进行匹配。结果为阑尾穿孔率、ED 治疗、住院结局和住院费用。
在 11 年的时间里，从 7 家医院共招募了 25766 名患者；其中，根据标准排除了 11513 名患者，剩余 14253 名患者进行了分析。SMI 组年龄较大（50.5 岁比 44.4 岁，p<0.01），女性比例较高（56.5%比 44.4%，p=0.01），Charlson 合并症指数较高。对匹配组的分析表明，SMI 组有更高比例的未计划在 72 小时内再次到 ED（17.9%比 10.4%，p=0.01）。阑尾穿孔率、ED 治疗、住院结局和住院费用无明显差异。
我们的研究表明，患有急性阑尾炎的 SMI 和非 SMI 患者的阑尾穿孔率、ED 管理、住院结局和住院费用无明显差异。在 SMI 组中，在诊断急性阑尾炎之前，有更高比例的未计划在 72 小时内再次到 ED。ED 健康提供者在处理有模糊症状或未指明腹部不适的 SMI 患者时需谨慎。
