Park Song Yi, Kim Sun Hyu, Choi Byungho
Department of Emergency Medicine, Ulsan University Hospital, Ulsan, Republic of Korea.
Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea.
Heliyon. 2024 Oct 18;10(20):e39506. doi: 10.1016/j.heliyon.2024.e39506. eCollection 2024 Oct 30.
This study evaluated the impact of an emergency department (ED) closure on out-of-hospital cardiac arrest survival outcomes and the emergency medical service system in Ulsan, South Korea.
We conducted a retrospective observational cohort study from March 2017 to February 2021 and compared survival to hospital discharge and favorable neurological outcomes. We investigated transport time intervals (TTIs) in the total study population and subgroup covered by the closed ED. The analysis methods included propensity score matching (PSM), inverse propensity weighting (IPW), and logistic regression analysis.
The study included 692 and 920 patients before and after ED closure groups, respectively. After adjusting for covariates, the adjusted odds ratios and 95 % confidence interval for survival discharge and favorable neurological outcomes were 1.040 (0.749-1.444, p = 0.814) and 2.845 (1.563-5.177, p = 0.001), respectively. PSM showed values of 1.015 (0.727-1.416, p = 0.932) for discharge survival and 1.777 (1.074-2.941, p = 0.025) for neurological outcomes. IPW showed values of 0.980 (0.762-1.261, p = 0.875) for discharge survival and 1.782 (1.196-2.656, p = 0.005) for neurological outcomes. The TTI increased from 5.8 ± 5.0 to 6.7 ± 5.5 min (p < 0.001) in the total population and from 9.2 ± 7.9 to 16.2 ± 6.5 min (p < 0.001) in the subgroup.
The findings suggest that while the overall system may remain stable, subgroups could be disproportionately affected by an ED closure, underscoring the importance of the ongoing monitoring of survival outcomes and transport times.
本研究评估了韩国蔚山一家急诊科关闭对院外心脏骤停生存结局及紧急医疗服务系统的影响。
我们进行了一项回顾性观察性队列研究，时间跨度为2017年3月至2021年2月，并比较了出院生存率和良好神经功能结局。我们调查了整个研究人群以及关闭急诊科所覆盖的亚组中的转运时间间隔（TTIs）。分析方法包括倾向得分匹配（PSM）、逆倾向加权（IPW）和逻辑回归分析。
该研究分别纳入了急诊科关闭前组的692例患者和关闭后组的920例患者。在对协变量进行调整后，出院生存和良好神经功能结局的调整优势比及95%置信区间分别为1.040（0.749 - 1.444，p = 0.814）和2.845（1.563 - 5.177，p = 0.001）。PSM显示出院生存的值为1.015（0.727 - 1.416，p = 0.932），神经功能结局的值为1.777（1.074 - 2.941，p = 0.025）。IPW显示出院生存的值为0.980（0.762 - 1.261，p = 0.875），神经功能结局的值为1.782（1.196 - 2.656，p = 0.005）。总人群中的TTI从5.8±5.0分钟增加到6.7±5.5分钟（p < 0.001），亚组中的TTI从9.2±7.9分钟增加到16.2±6.5分钟（p < 0.001）。
研究结果表明，虽然整个系统可能保持稳定，但亚组可能会受到急诊科关闭的不成比例影响，这突出了持续监测生存结局和转运时间的重要性。
