Herlitz Sebastian, Ohm Joel, Häbel Henrike, Ekelund Ulf, Hofmann Robin, Svensson Per
Department of Clinical Science and Education, Södersjukhuset Karolinska Institutet Stockholm Sweden.
Department of Medicine, Solna Karolinska Institutet Stockholm Sweden.
J Am Coll Emerg Physicians Open. 2023 Jul 8;4(4):e13005. doi: 10.1002/emp2.13005. eCollection 2023 Aug.
Emergency department length of stay (EDLOS) is linked to crowding and patient outcomes whereas worse prognosis in low socioeconomic status remains poorly understood. We studied whether income was associated with ED process times among patients with chest pain.
This was a registry-based cohort study on 124,980 patients arriving at 14 Swedish EDs between 2015 and 2019 with chest pain as their chief complaint. Individual-level sociodemographic and clinical data were linked from multiple national registries. The associations between disposable income quintiles, whether the time to physician assessment exceeded triage priority recommendations as well as EDLOS were evaluated using crude and multivariable regression models adjusted for age, gender, sociodemographic variables, and ED-management circumstances.
Patients with the lowest income were more likely to be assessed by physician later than triage recommendations (crude odds ratio [OR] 1.25 (95% confidence interval [CI] 1.20-1.29) and have an EDLOS exceeding 6 h (crude OR 1.22 (95% CI 1.17-1.27). Among patients subsequently diagnosed with major adverse cardiac events, patients with the lowest income were more likely to be assessed by a physician later than triage recommendations, crude OR 1.19 (95% CI 1.02-1.40). In the fully adjusted model, the average EDLOS was 13 min (5.6%) longer among patients in the lowest income quintile, 4:11 [h:min], (95% CI 4:08-4:13), compared to patients in the highest income quintile, 3:58 (95% CI 3:56-4:00).
Among ED chest pain patients, low income was associated with longer time to physician than recommended by triage and longer EDLOS. Longer process times may have a negative impact due to crowding in the ED and delay diagnosis and timely treatment of the individual patient.
急诊科留观时间（EDLOS）与拥挤程度及患者预后相关，而社会经济地位较低者预后较差的情况仍了解不足。我们研究了胸痛患者的收入与急诊流程时间是否相关。
这是一项基于登记的队列研究，研究对象为2015年至2019年间前往瑞典14家急诊科就诊、以胸痛为主诉的124980例患者。个体层面的社会人口统计学和临床数据来自多个国家登记处。使用校正了年龄、性别、社会人口统计学变量和急诊管理情况的粗回归模型和多变量回归模型，评估可支配收入五分位数、医生评估时间是否超过分诊优先级建议以及EDLOS之间的关联。
收入最低的患者比分诊建议时间更晚接受医生评估的可能性更高（粗比值比[OR]为1.25（95%置信区间[CI]为1.20 - 1.29）），且EDLOS超过6小时的可能性更高（粗OR为1.22（95%CI为1.17 - 1.27））。在随后被诊断为重大不良心脏事件的患者中，收入最低的患者比分诊建议时间更晚接受医生评估的可能性更高，粗OR为1.19（95%CI为1.02 - 1.40）。在完全校正模型中，收入最低五分位数的患者的平均EDLOS比收入最高五分位数的患者长13分钟（5.6%），分别为4:11[小时:分钟]（95%CI为4:08 - 4:13）和3:58（95%CI为3:56 - 4:00）。
在急诊科胸痛患者中，低收入与比分诊建议更长的医生评估时间以及更长的EDLOS相关。由于急诊科拥挤，更长的流程时间可能会产生负面影响，并延误个体患者的诊断和及时治疗。
