Taylor J, Lawrie S, Geddes J
Dingleton Hospital, Melrose.
Health Bull (Edinb). 1996 Nov;54(6):467-73.
Psychiatric emergencies account for a large proportion of total referrals and admissions yet there has been little research in the United Kingdom into factors associated with admission after emergency psychiatric assessment. We conducted a one year prospective study of all emergency referrals from Borders Region in Scotland. Four hundred and eighty-seven emergencies were assessed and 153 (31%) of these were admitted. The main predictors of admission after stepwise logistic regression analysis were: risk to self (odds ratio 1.76 for each point increment on a five point scale, 95% confidence intervals 1.43 to 2.15), current contact with the psychiatric services (2.46; 1.52, 3.98) and psychotic diagnosis (2.38; 1.47, 3.87). Compared to subjects assessed at home, those assessed at the psychiatric hospital were more likely to be admitted (3.73; 1.99, 6.99) and self-referrals were less likely to be admitted than General Practitioner referrals (0.22; 0.08, 0.55). Our results suggest that future studies of emergency services should investigate and control for both clinical and service variables.
精神科急症在全部转诊和住院病例中占很大比例，但在英国，针对急诊精神科评估后住院相关因素的研究却很少。我们对苏格兰边境地区所有的急诊转诊病例进行了为期一年的前瞻性研究。共评估了487例急症病例，其中153例（31%）住院。逐步逻辑回归分析后，住院的主要预测因素为：对自身的风险（五分制量表上每增加一分，比值比为1.76，95%置信区间为1.43至2.15）、目前与精神科服务机构的接触（2.46；1.52，3.98）以及精神病诊断（2.38；1.47，3.87）。与在家中接受评估的患者相比，在精神病医院接受评估的患者更有可能住院（3.73；1.99，6.99），而且自我转诊患者比全科医生转诊患者住院的可能性更小（0.22；0.08，0.55）。我们的结果表明未来针对急诊服务的研究应调查并控制临床和服务变量。
