主要主诉、潜在诊断和成人非创伤急诊就诊的死亡率：一项基于人群的多中心队列研究。
Chief Complaints, Underlying Diagnoses, and Mortality in Adult, Non-trauma Emergency Department Visits: A Population-based, Multicenter Cohort Study.
机构信息
University of Southern Denmark, Department of Clinical Research, Odense, Denmark.
University Hospital of Southern Denmark, Department of Emergency Medicine, Aabenraa, Denmark.
出版信息
West J Emerg Med. 2022 Oct 31;23(6):855-863. doi: 10.5811/westjem.2022.9.56332.
INTRODUCTION
Knowledge about the relationship between symptoms, diagnoses, and mortality in emergency department (ED) patients is essential for the emergency physician to optimize treatment, monitoring, and flow. In this study, we investigated the association between symptoms and discharge diagnoses; symptoms and mortality; and we then analyzed whether the association between symptoms and mortality was influenced by other risk factors.
METHODS
This was a population-based, multicenter cohort study of all non-trauma ED patients ≥18 years who presented at a hospital in the Region of Southern Denmark between January 1, 2016-March 20, 2018. We used multivariable logistic regression to examine the association between symptoms and mortality adjusted for other risk factors.
RESULTS
We included 223,612 ED visits with a median patient age of 63 and even distribution of females and males. The frequency of the chief complaints at presentation were as follows: non-specific symptoms (19%); abdominal pain (16%); dyspnea (12%); fever (8%); chest pain (8%); and neurologic complaints (7%). Discharge diagnoses were symptom-based (24%), observational (hospital visit for observation or examination, 17%), circulatory (12%), or respiratory (12%). The overall 30-day mortality was 3.5%, with 1.7% dead within 0-7 days and 1.8% within 8-30 days. The presenting symptom was associated with mortality at 0-7 days but not with mortality at 8-30 days. Patients whose charts were missing documentation of symptoms (adjusted odds ratio [aOR] 3.5) and dyspneic patients (aOR 2.4) had the highest mortality at 0-7 days across patients with different primary symptoms. Patients ≥80 years and patients with a higher degree of comorbidity had increased mortality from 0-7 days to 8-30 days (aOR from 24.0 to 42.7 and 1.9 to 2.8, respectively).
CONCLUSION
Short-term mortality was more strongly associated with patient-related factors than with the primary presenting symptom at arrival to the hospital.
简介
了解急诊科（ED）患者症状、诊断和死亡率之间的关系对于急诊医生优化治疗、监测和流程至关重要。在这项研究中，我们调查了症状与出院诊断之间的关系；症状与死亡率之间的关系；然后分析了症状与死亡率之间的关系是否受到其他危险因素的影响。
方法
这是一项基于人群的多中心队列研究，纳入了 2016 年 1 月 1 日至 2018 年 3 月 20 日期间在丹麦南部地区医院就诊的所有≥18 岁的非创伤性 ED 患者。我们使用多变量逻辑回归来检查调整其他危险因素后症状与死亡率之间的关系。
结果
共纳入 223612 例 ED 就诊患者，患者的中位年龄为 63 岁，女性和男性的分布均匀。就诊时的主要症状频率如下：非特异性症状（19%）；腹痛（16%）；呼吸困难（12%）；发热（8%）；胸痛（8%）；和神经系统症状（7%）。出院诊断为基于症状的诊断（24%）、观察性诊断（因观察或检查而住院，17%）、循环系统诊断（12%）或呼吸系统诊断（12%）。总的 30 天死亡率为 3.5%，0-7 天内死亡的比例为 1.7%，8-30 天内死亡的比例为 1.8%。就诊时的症状与 0-7 天内的死亡率相关，但与 8-30 天内的死亡率无关。病历中未记录症状的患者（调整后的优势比[aOR]3.5）和呼吸困难的患者（aOR2.4）在不同主要症状的患者中，0-7 天内的死亡率最高。≥80 岁的患者和合并症程度较高的患者从 0-7 天至 8-30 天的死亡率均升高（aOR 分别从 24.0 增加到 42.7 和从 1.9 增加到 2.8）。
结论
短期死亡率与患者相关因素的关系比到达医院时的主要就诊症状更为密切。
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