The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan.
Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
Front Public Health. 2024 May 30;12:1391519. doi: 10.3389/fpubh.2024.1391519. eCollection 2024.
In many countries, emergency medical systems were responsible for initial treatment of patients with COVID-19. Generally, acceptance by medical institutions may not be sufficient, and it may take much time to determine the medical institution to which to transport the patient. This problem is termed "difficulty in hospital acceptance (DIH)," and it is used as a key performance indicator in the assessment of the EMS in Japan. The purpose of this study was to reveal the factors associated with the DIH during the COVID-19 pandemic using dataset in the ORION (Osaka emergency information Research Intelligent Operation Network system).
This was a retrospective descriptive study with a 3-year study period from January 1, 2019 to December 31, 2021. We included patients who were recorded in the ORION system during the study period. The primary endpoint was defined as DIH. Multivariable logistic regression model was used to assess factors associated with DIH during the COVID-19 pandemic and calculated their adjusted odds ratio (AOR) and associated 95% confidence interval (CI).
1,078,850 patients included in this study. Of them, 41,140 patients (3.8%) experienced DIH and 1,037,710 patients (96.2%) did not experience DIH. The median age was 71 years (IQR: 45-82), and 543,760 patients (50.4%) were male. In this study, SpO, body temperature, and epidemic period of COVID-19 were associated with difficulty in hospital acceptance. The highest AOR of SpO2 was 80% or less (AOR: 1.636, [95% CI: 1.532-1.748]), followed by 81-85% (AOR: 1.584, [95% CI: 1.459-1.721]). The highest AOR of body temperature was 38.0-38.9°C (AOR: 1.969 [95% CI: 1.897-2.043]), followed by 39°C or higher (AOR: 1.912 [95% CI: 1.829-1.998]). The highest AOR of epidemic period of COVID-19 was the 4th wave (AOR: 2.134, [95% CI: 2.065-2.205]), followed by the 3rd wave (AOR: 1.842, [95% CI: 1.785-1.901]).
In this study, we revealed factors associated with the DIH during the COVID-19 pandemic. As various factors are involved in the spread of an unknown infectious disease, it is necessary not only to plan in advance but also to take appropriate measures according to the situation in order to smoothly accept emergency patients.
在许多国家，紧急医疗系统负责对 COVID-19 患者进行初步治疗。一般来说，医疗机构的接收能力可能不足，确定将患者转运到哪家医疗机构可能需要很长时间。这个问题被称为“入院困难（DIH）”，并被用作日本 EMS 评估的关键绩效指标。本研究的目的是使用 ORION（大阪紧急信息研究智能运营网络系统）中的数据集，揭示 COVID-19 大流行期间与 DIH 相关的因素。
这是一项回顾性描述性研究，研究期间为 2019 年 1 月 1 日至 2021 年 12 月 31 日，共 3 年。我们纳入了研究期间记录在 ORION 系统中的患者。主要终点定义为 DIH。多变量逻辑回归模型用于评估 COVID-19 大流行期间与 DIH 相关的因素，并计算其调整后的优势比（AOR）及其相关的 95%置信区间（CI）。
本研究共纳入 1078850 例患者。其中，41140 例（3.8%）患者经历了 DIH，1037710 例（96.2%）患者未经历 DIH。中位年龄为 71 岁（IQR：45-82），543760 例（50.4%）为男性。在这项研究中，SpO2、体温和 COVID-19 的流行期与入院困难有关。SpO2 最低 80%或更低的 AOR 最高（AOR：1.636，[95%CI：1.532-1.748]），其次是 81-85%（AOR：1.584，[95%CI：1.459-1.721]）。体温最高 38.0-38.9°C 的 AOR 最高（AOR：1.969，[95%CI：1.897-2.043]），其次是 39°C 或更高（AOR：1.912，[95%CI：1.829-1.998]）。COVID-19 流行期的最高 AOR 为第 4 波（AOR：2.134，[95%CI：2.065-2.205]），其次是第 3 波（AOR：1.842，[95%CI：1.785-1.901]）。
在这项研究中，我们揭示了 COVID-19 大流行期间与 DIH 相关的因素。由于未知传染病的传播涉及各种因素，不仅需要提前计划，还需要根据情况采取适当的措施，以便顺利接收急诊患者。
