Blayney Michael C, Reed Matthew J, Masterson John A, Anand Atul, Bouamrane Matt M, Fleuriot Jacques, Luz Saturnino, Lyall Marcus J, Mercer Stewart, Mills Nicholas L, Shenkin Susan D, Walsh Timothy S, Wild Sarah H, Wu Honghan, McLachlan Stela, Guthrie Bruce, Lone Nazir I
Department of Anaesthesia, Critical Care and Pain Medicine, Usher Institute, University of Edinburgh, Edinburgh, UK.
Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK.
BMJ Med. 2024 Aug 16;3(1):e000731. doi: 10.1136/bmjmed-2023-000731. eCollection 2024.
To describe the effect of multimorbidity on adverse patient centred outcomes in people attending emergency department.
Population based cohort study.
Emergency departments in NHS Lothian in Scotland, from 1 January 2012 to 31 December 2019.
Adults (≥18 years) attending emergency departments.
Linked data from emergency departments, hospital discharges, and cancer registries, and national mortality data.
Multimorbidity was defined as at least two conditions from the Elixhauser comorbidity index. Multivariable logistic or linear regression was used to assess associations of multimorbidity with 30 day mortality (primary outcome), hospital admission, reattendance at the emergency department within seven days, and time spent in emergency department (secondary outcomes). Primary analysis was stratified by age (<65 ≥65 years).
451 291 people had 1 273 937 attendances to emergency departments during the study period. 43 504 (9.6%) had multimorbidity, and people with multimorbidity were older (median 73 43 years), more likely to arrive by emergency ambulance (57.8% 23.7%), and more likely to be triaged as very urgent (23.5% 9.2%) than people who do not have multimorbidity. After adjusting for other prognostic covariates, multimorbidity, compared with no multimorbidity, was associated with higher 30 day mortality (8.2% 1.2%, adjusted odds ratio 1.81 (95% confidence interval (CI) 1.72 to 1.91)), higher rate of hospital admission (60.1% 20.5%, 1.81 (1.76 to 1.86)), higher reattendance to an emergency department within seven days (7.8% 3.5%, 1.41 (1.32 to 1.50)), and longer time spent in the department (adjusted coefficient 0.27 h (95% CI 0.26 to 0.27)). The size of associations between multimorbidity and all outcomes were larger in younger patients: for example, the adjusted odds ratio of 30 day mortality was 3.03 (95% CI 2.68 to 3.42) in people younger than 65 years versus 1.61 (95% CI 1.53 to 1.71) in those 65 years or older.
Almost one in ten patients presenting to emergency department had multimorbidity using Elixhauser index conditions. Multimorbidity was strongly associated with adverse outcomes and these associations were stronger in younger people. The increasing prevalence of multimorbidity in the population is likely to exacerbate strain on emergency departments unless practice and policy evolve to meet the growing demand.
描述多种疾病共存对急诊科就诊患者以患者为中心的不良结局的影响。
基于人群的队列研究。
2012年1月1日至2019年12月31日期间，苏格兰NHS洛锡安地区的急诊科。
急诊科就诊的成年人（≥18岁）。
来自急诊科、医院出院记录、癌症登记处的关联数据以及国家死亡率数据。
多种疾病共存定义为根据埃利克斯豪泽共病指数至少患有两种疾病。采用多变量逻辑回归或线性回归评估多种疾病共存与30天死亡率（主要结局）、住院、7天内再次到急诊科就诊以及在急诊科停留时间（次要结局）之间的关联。主要分析按年龄（<65岁、≥65岁）分层。
在研究期间，451291人到急诊科就诊1273937次。43504人（9.6%）患有多种疾病，与未患多种疾病的人相比，患有多种疾病的人年龄更大（中位数73岁对43岁），更有可能通过急救救护车送达（57.8%对23.7%），并且更有可能被分诊为非常紧急（23.5%对9.2%）。在调整其他预后协变量后，与未患多种疾病相比，多种疾病共存与更高的30天死亡率相关（8.2%对1.2%，调整后的优势比为1.81（95%置信区间（CI）1.72至1.91））、更高的住院率（60.1%对20.5%，1.81（1.76至1.86））、7天内再次到急诊科就诊的比例更高（7.8%对3.5%，1.41（1.32至1.50））以及在急诊科停留时间更长（调整系数0.27小时（95%CI0.26至0.27））。多种疾病共存与所有结局之间的关联在年轻患者中更大：例如，<65岁人群中30天死亡率的调整后优势比为3.03（95%CI2.68至3.42），而65岁及以上人群为1.61（95%CI1.53至1.71）。
使用埃利克斯豪泽指数条件，近十分之一到急诊科就诊的患者患有多种疾病。多种疾病共存与不良结局密切相关，且这些关联在年轻人中更强。除非实践和政策有所发展以满足不断增长的需求，否则人群中多种疾病共存患病率的上升可能会加剧急诊科的压力。
