University of Hull, Hull, United Kingdom.
Emergency Department, Consultant in Emergency Medicine, Hull Royal Infirmary, Hull University Teaching Hospitals Trust, Hull, United Kingdom.
PLoS One. 2023 Aug 15;18(8):e0289263. doi: 10.1371/journal.pone.0289263. eCollection 2023.
Breathlessness due to medical conditions commonly causes emergency department presentations and unplanned admissions. Acute-on-chronic breathlessness is a reason for 20% of emergency presentations by ambulance with 69% of these being admitted. The emergency department may be inappropriate for many presenting with acute-on-chronic breathlessness.
To examine predictors of emergency department departure status in people with acute-on-chronic breathlessness.
DESIGN, SETTING AND METHOD: Secondary analysis of patient-report survey and clinical record data from consecutive eligible attendees by ambulance. Variables associated with emergency department departure status (unifactorial analyses; p<0.05) were included in a binary logistic regression model. The study was conducted in a single tertiary hospital. Consecutive survey participants presenting in May 2015 with capacity were eligible. 1,212/1,345 surveys were completed. 245/1,212 presented with acute-on-chronic breathlessness, 171 of whom consented to clinical record review and were included in this analysis.
In the final model, the odds of admission were increased with every extra year of age [OR 1.041 (95% CI: 1.016 to 1.066)], having talked to a specialist doctor about breathlessness [9.262 (1.066 to 80.491)] and having a known history of a heart condition [4.177 (1.680 to 10.386)]. Odds of admission were decreased with every percentage increase in oxygen saturation [0.826 (0.701 to 0.974)].
Older age, lower oxygen saturation, having talked to a specialist, and having history of a cardiac condition predict hospital admission in people presenting to the emergency department with acute-on-chronic breathlessness. These clinical factors could be assessed in the community and may inform the decision regarding conveyance.
由医疗条件引起的呼吸困难通常导致急诊科就诊和非计划性住院。慢性基础上的急性呼吸困难是急诊科通过救护车就诊的 20%的原因，其中 69%的人需要住院治疗。对于许多因慢性基础上的急性呼吸困难而就诊的患者来说，急诊科可能并不合适。
探讨慢性基础上的急性呼吸困难患者急诊科离院状态的预测因素。
设计、地点和方法：对通过救护车连续就诊且符合条件的患者的患者报告调查和临床记录数据进行二次分析。将与急诊科离院状态相关的变量（单因素分析；p<0.05）纳入二项逻辑回归模型。该研究在一家三级医院进行。符合条件的患者为 2015 年 5 月在有能力的情况下通过救护车就诊的连续调查参与者。完成了 1212 份/1345 份调查。245 名/1212 名患者因慢性基础上的急性呼吸困难就诊，其中 171 名同意进行临床记录审查并纳入本分析。
在最终模型中，年龄每增加 1 岁，住院的可能性就增加 1.041 倍（95%CI：1.016 至 1.066）[OR 1.041 (95% CI: 1.016 to 1.066)]，与专科医生谈论过呼吸困难[9.262 (1.066 to 80.491)]，有已知的心脏疾病史[4.177 (1.680 to 10.386)]。每增加 1%的血氧饱和度，住院的可能性就降低 0.826 倍（0.701 至 0.974）[OR 0.826 (0.701 to 0.974)]。
年龄较大、血氧饱和度较低、与专科医生交谈过以及有心脏疾病史预测了因慢性基础上的急性呼吸困难而就诊的患者入住急诊科。这些临床因素可以在社区进行评估，并可能为运输决策提供信息。
