Department of Anesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia.
Department of Anesthesiology and Intensive Care, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.
Eur J Trauma Emerg Surg. 2023 Jun;49(3):1375-1381. doi: 10.1007/s00068-023-02263-3. Epub 2023 Mar 30.
Abdominal pain is one of the most frequent causes for emergency department (ED) visits. The quality of care and outcomes are determined by time-dependent interventions with barriers to implementation at crowded EDs.
The study aimed to analyze three prominent quality indicators (QI) including pain assessment (QI1), analgesia in patients reporting severe pain (QI2), and ED length of stay (LOS) (QI3) in adult patients requiring immediate or urgent care due to acute abdominal pain. We aimed to characterize current practice regarding pain management, and we hypothesized that extended ED LOS (≥ 360 min) is associated with poor outcomes in this cohort of ED referrals.
This is a retrospective cohort study enrolling all patients with acute abdominal pain as the main cause of ED presentation, triage category red, orange, or yellow, and age ≥ 30 years during two months period. Univariate and multivariable analyses were deployed to determine independent risk factors for QIs performance. For QI1 and QI2, compliance with the QIs were analyzed, while 30-day mortality was set as primary outcome for QI3.
Overall, 965 patients were analyzed including 501 (52%) males with a mean age of 61.8 years. Seventeen percent (167/965) of the patients had immediate or very urgent triage category. Age ≥ 65 years, and red and orange triage categories were risk factors for non-compliance with pain assessment. Seventy four per cent of patients with severe pain (numeric rating scale ≥ 7) received analgesia during the ED visit, in median within 64 min (IQR 35-105 min). Age ≥ 65 years and need for surgical consultation were risk factors for prolonged ED stay. After adjustment to age, gender and triage category, ED LOS ≥ 360 min proved to be independent risk factor for 30-day mortality (HR 1.89, 95% CI 1.71-3.40, p = 0.034).
Our investigation identified that non-compliance with pain assessment, analgesia and ED length of stay among patients presenting with abdominal pain to ED results in poor quality of care and detrimental outcomes. Our data support enhanced quality-assessment initiatives for this subset of ED patients.
腹痛是急诊科（ED）就诊最常见的原因之一。医疗质量和结果取决于与拥挤的 ED 实施相关的障碍有关的时间依赖性干预。
本研究旨在分析三个突出的质量指标（QI），包括疼痛评估（QI1）、报告严重疼痛的患者的镇痛（QI2）和 ED 住院时间（LOS）（QI3），这些指标适用于因急性腹痛而需要紧急或紧急护理的成年患者。我们旨在描述当前疼痛管理的实践情况，并假设在这个 ED 转介患者队列中，延长 ED LOS（≥360 分钟）与不良结果相关。
这是一项回顾性队列研究，纳入了两个月期间因急性腹痛为主诉、分诊类别为红色、橙色或黄色且年龄≥30 岁的所有患者。采用单变量和多变量分析来确定 QI 表现的独立危险因素。对于 QI1 和 QI2，分析了对 QI 的依从性，而 30 天死亡率则作为 QI3 的主要结果。
共有 965 例患者纳入分析，其中 501 例（52%）为男性，平均年龄为 61.8 岁。17%（167/965）的患者有紧急或非常紧急的分诊类别。年龄≥65 岁以及红色和橙色分诊类别是疼痛评估不合规的危险因素。74%（疼痛评分≥7 的严重疼痛患者在 ED 就诊期间接受了镇痛治疗，中位数为 64 分钟（IQR 35-105 分钟）。年龄≥65 岁和需要手术咨询是 ED 住院时间延长的危险因素。调整年龄、性别和分诊类别后，ED LOS≥360 分钟被证明是 30 天死亡率的独立危险因素（HR 1.89，95%CI 1.71-3.40，p=0.034）。
我们的调查发现，ED 就诊的腹痛患者在疼痛评估、镇痛和 ED 住院时间方面的不合规导致了较差的医疗质量和不良结局。我们的数据支持针对这部分 ED 患者加强质量评估计划。
