Shapiro Susan, Majert Jeannette, Obeidalla Abubaker, Clift Alex, Havord Sarah, Jebamani Angelin, Matejtschuk Charlotte, Clarke Penney, Lasserson Daniel
Department of Haematology, Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom.
Department of Haematology, Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Nuffield Department of Women's and Reproductive Health, Medical Science Division, University of Oxford, Oxford, United Kingdom.
J Thromb Haemost. 2025 Jan;23(1):97-107. doi: 10.1016/j.jtha.2024.09.017.
Same-day emergency care (SDEC) is an expanding area of hospital acute medical care. It aims to minimize delays and manage medical emergency patients within the same day, enabling hospitalization to be avoided; the expectation is that the patients would have required inpatient hospitalization in the absence of the SDEC service. Venous thromboembolism (VTE) prevention is a key medical inpatient safety measure. Whether VTE prevention should be considered for SDEC patients is unknown.
To examine the incidence and predictors of VTE diagnosed within 90 days of SDEC assessment.
Data were obtained from electronic health records of people who received SDEC at our hospital during a 5-year period (April 2016 to March 2021).
There were 40 045 attendance episodes by 33 715 individuals. Median age was 60 years (IQR, 41.0-76.0 years), and 55.2% were women. Three hundred forty-nine patients (0.9%) developed a VTE within 90 days of SDEC. Increased risk of VTE was associated with age more than 60 years, prior malignancy (adjusted odds ratio [OR], 4.12; 95% CI, 3.19-5.32; P < .0001), history of diseases of the circulatory system (adjusted OR, 2.92; 95% CI, 2.27-3.76; P < .0001), and having 1 or more additional SDEC attendances within 30 days (adjusted OR, 4.61; 95% CI, 3.65-5.82; P < .0001). In the 90 days prior to VTE diagnosis, 36.6% of patients had a separate inpatient admission in addition to SDEC. There was no association with completion of an electronic VTE risk assessment (adjusted OR, 0.96; 95% CI, 0.76-1.20).
The incidence of VTE following SDEC is similar to that reported for symptomatic VTE in traditional medical inpatients without thromboprophylaxis.
当日急诊护理（SDEC）是医院急性医疗护理中一个不断扩展的领域。其目的是尽量减少延误，并在同一天内处理医疗急症患者，从而避免住院治疗；预期是如果没有SDEC服务，这些患者本需要住院治疗。静脉血栓栓塞（VTE）预防是一项关键的住院患者医疗安全措施。对于SDEC患者是否应考虑进行VTE预防尚不清楚。
研究SDEC评估后90天内诊断出的VTE的发生率和预测因素。
数据来自于我院在5年期间（2016年4月至2021年3月）接受SDEC治疗的患者的电子健康记录。
33715名患者共出现40045次就诊情况。中位年龄为60岁（四分位间距，41.0 - 76.0岁），女性占55.2%。349名患者（0.9%）在SDEC后90天内发生了VTE。VTE风险增加与年龄超过60岁、既往有恶性肿瘤（调整后的优势比[OR]，4.12；95%可信区间[CI]，3.19 - 5.32；P <.0001）、循环系统疾病史（调整后的OR，2.92；95% CI，2.27 - 3.76；P <.0001）以及在30天内有1次或更多次额外的SDEC就诊（调整后的OR，4.61；95% CI，3.65 - 5.82；P <.0001）有关。在VTE诊断前的90天内，36.6%的患者除了SDEC外还进行了单独的住院治疗。与完成电子VTE风险评估无关（调整后的OR，0.96；95% CI，0.76 - 1.20）。
SDEC后VTE的发生率与未进行血栓预防的传统内科住院患者中症状性VTE的报告发生率相似。
