Registrar, Department of Otolaryngology, Head and Neck Surgery, Te Whatu Ora Te Toka Tumai, Auckland.
Training Registrar, Department of General Surgery, Te Whatu Ora Southern, Invercargill.
N Z Med J. 2023 May 12;136(1575):22-32. doi: 10.26635/6965.6063.
Otorhinolaryngology, head and neck surgery (ORL) diagnoses and treats disorders of the ear, nose, throat, head and neck which can be commonly seen across a range of medical specialities. Rural patients experience a burden of ORL diseases and face greater barriers to healthcare than their urban counterparts. We aim to provide information on the diagnoses of rural patients presenting with ORL symptomatology to provide data that may be useful in targeting resources and training towards rural patients.
A 6-year retrospective study was performed between 1 January 2015 to 31 December 2020. The Northland District Health Board (NDHB) data warehouse was searched using ICD-10 codes relevant to ORL. The study included any patient acutely presenting to an NDHB hospital with an ORL diagnosis. Patients with a diagnosis that was not related to ORL, a non-acute presentation, or a diagnosis not usually managed by hospital ORL services were excluded.
Five thousand, five hundred and thirty-four presentations in 4,671 individual patients were included in the study. The mean age of patients was 35.1 years (SD 26.58). Two thousand, three hundred and twenty-six (49.8%) patients were female and 2,345 (50.2%) were male. One thousand, nine hundred and sixty-five (42.1%) were Māori and 2,699 (57.8%) were non-Māori. Median decile was 8 (4 IQR). Two thousand and seventy-seven (44.5%) patients were classified as rural and 2,594 (55.5%) as urban. The most common presentation was epistaxis with 16.8% (n=927/5534) of total presentations. The four next most common presentations were otological. There was a total of 224 complications including post-operative bleed, post-operative infection, and other post-operative complications. There was a significant difference in the rate of discharge with 1,819/2,430 (74.9%) rural patients and 2,518/3,104 (81.1%) urban patients being discharged directly from the emergency department (ED) (p <0.001).
This retrospective study provides a picture of acute ORL presentations in Northland patients, analysed with respect to geography and rurality. It highlights the large volume of ORL patients who are seen and managed by rural and ED physicians, and the importance of rural provision of care in Northland. These findings support the need for targeting resources and training to centres treating rural patients for the management and treatment of ORL conditions.
耳鼻喉头颈外科学（ORL）诊断和治疗耳、鼻、喉、头颈部的疾病，这些疾病在许多医学专业中都很常见。农村患者患 ORL 疾病的负担更大，并且比城市患者面临更大的医疗保健障碍。我们旨在提供有关农村患者出现 ORL 症状的诊断信息，以提供可能有助于针对农村患者的资源和培训的数据。
进行了一项为期 6 年的回顾性研究，时间为 2015 年 1 月 1 日至 2020 年 12 月 31 日。使用与 ORL 相关的 ICD-10 代码在北地地区卫生局（NDHB）数据仓库中进行搜索。该研究包括任何因 ORL 诊断而急性就诊于 NDHB 医院的患者。排除了诊断与 ORL 无关、非急性就诊或诊断通常不由医院 ORL 服务管理的患者。
在这项研究中，共有 4671 名患者中的 5534 次就诊，平均年龄为 35.1 岁（标准差 26.58）。2326 名（49.8%）患者为女性，2345 名（50.2%）为男性。1965 名（42.1%）为毛利人，2699 名（57.8%）为非毛利人。中位数为 8（四分位距）。277 名（44.5%）患者被归类为农村患者，2594 名（55.5%）为城市患者。最常见的表现是鼻出血，占总就诊人数的 16.8%（n=927/5534）。接下来最常见的四个表现是耳科。共有 224 例并发症，包括术后出血、术后感染和其他术后并发症。农村患者中有 1819/2430（74.9%）直接从急诊室（ED）出院，城市患者中有 2518/3104（81.1%）出院（p<0.001），出院率有显著差异。
这项回顾性研究提供了北地地区急性 ORL 患者就诊情况的图片，并根据地理位置和农村情况进行了分析。它突出了大量由农村和 ED 医生诊治的 ORL 患者，以及北地农村提供护理的重要性。这些发现支持将资源和培训集中到治疗农村患者的中心，以治疗 ORL 疾病。
