重症监护病房之间医院内转科后死亡的间接风险因素——一项瑞典登记研究

Circumstantial risk factors for death after intensive care unit-to-unit inter-hospital transfer-a Swedish registry study.

作者信息

Sternley Jesper, Stattin Karl, Petzold Max, Oras Jonatan, Rylander Christian

机构信息

Anaesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, 715 85, Uppsala, Sweden.

School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.

出版信息

Scand J Trauma Resusc Emerg Med. 2025 Jan 29;33(1):14. doi: 10.1186/s13049-025-01325-2.

DOI:10.1186/s13049-025-01325-2

PMID:39881339

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11780853/

Abstract

BACKGROUND

Unit-to-unit transfer of critically ill patients infers hazards that may cause adverse events. Circumstantial factors associated with mortality after intensive care include days in the ICU, night-time or weekend discharge and capacity transfer as compared to other reasons for transfer. Distance travelled may also constitute an indirect risk. The aim of this study was to assess potential associations between these circumstantial factors and the risk of death 30 days after transfer.

METHODS

Data from 2015 to 2019 was retrieved from the Swedish Intensive Care Registry. Logistic regression was used for risk analysis.

RESULTS

Among 4,327 patients, 965 (22%) were deceased 30 days after transfer. 1351 patients undergoing capacity transfer had a higher morbidity than patients transferred for other reasons. Using univariable logistic regression, days spent in the referring ICU before transfer, capacity transfer as compared to clinical transfer and repatriation as well as SAPS3 in the receiving ICU were associated with a higher risk of death at 30 days. However, after multivariable regression with adjustment for ICD-10 diagnosis and Standardised Mortality Rate in the receiving ICU, these associations were lost.

CONCLUSION

Our results suggest that inter-hospital transfer is safe to carry out at any time of day and over shorter as well as longer distances.

摘要

背景

重症患者在不同医疗单元之间的转运存在可能导致不良事件的风险。重症监护后与死亡率相关的间接因素包括在重症监护病房（ICU）的住院天数、夜间或周末出院以及因床位紧张而转运（与其他转运原因相比）。转运距离也可能构成间接风险。本研究的目的是评估这些间接因素与转运后30天死亡风险之间的潜在关联。

方法

从瑞典重症监护登记处获取2015年至2019年的数据。采用逻辑回归进行风险分析。

结果

在4327例患者中，965例（22%）在转运后30天死亡。因床位紧张而转运的1351例患者的发病率高于因其他原因转运的患者。使用单变量逻辑回归分析，转运前在转诊ICU的住院天数、与临床转运及遣返相比的床位紧张转运以及接收ICU中的简化急性生理学评分系统Ⅲ（SAPS3）与30天死亡风险较高相关。然而，在对接收ICU中的国际疾病分类第10版（ICD - 10）诊断和标准化死亡率进行调整的多变量回归分析后，这些关联消失了。