Strange G R, Chen E H
Department of Emergency Medicine, College of Medicine, University of Illinois at Chicago, 60612, USA.
Acad Emerg Med. 1998 Dec;5(12):1157-62. doi: 10.1111/j.1553-2712.1998.tb02688.x.
To compare the use of emergency medical care by elders in the United States in 1995 with that previously described for 1990.
A computerized billing database of 88 EDs in 21 states was retrospectively reviewed for 1995, comparing elder and nonelder patients, estimating national use of emergency medical services by elders, and comparing the 1995 data with previously published results for 1990.
From 1990 to 1995, the number of ED visits in the United States increased from 92 million to 100 million. The number of visits made by patients aged 65 years or older increased from 13,639,400 (15%) to 15,666,300 (15.7%), but this increase did not reach statistical significance (p = 0.17). The admission rate for elder ED patients increased from 32% to 46% over the five-year interval (p<0.01). This represents more than 7 million hospital admissions for elder patients in 1995. The rate of intensive care unit (ICU) admission for elders decreased from 7% to 6% over the five-year interval (p = 0.56), compared with 1.3% for nonelder patients for both years. Thirty percent of elder ED patients arrived by ambulance in 1990, compared with 33% in 1995 (p = 0.02). Based on 1995 data, elders comprised 39% of patients arriving by ambulance [odds ratio (OR) 4.75, 95% confidence interval (CI) = 4.71 to 4.79], 43% of all admissions (OR 6.59, 95% CI = 6.54 to 6.64), and 47% of ICU admissions (OR 5.00, 95% CI = 4.91 to 5.09). The comparable ORs in 1990 were 4.4, 5.6, and 5.5, respectively.
From 1990 to 1995, the overall number of ED visits increased. The rate of increase was somewhat greater for elder patients. The use of ambulance services also disproportionately grew among elder patients, as did the rate of hospital admission. The overall rate of ICU admission was stable, but actually fell modestly for elder patients. Of these changes, only the increase in the rate of hospital admission for elders reached statistical significance.
比较1995年美国老年人使用急诊医疗服务的情况与之前描述的1990年的情况。
对21个州88家急诊科的计算机计费数据库进行回顾性分析，以研究1995年的情况，比较老年患者和非老年患者，估算全国老年人使用急诊医疗服务的情况，并将1995年的数据与之前发表的1990年的结果进行比较。
从1990年到1995年，美国急诊科就诊人次从9200万增加到1亿。65岁及以上患者的就诊人次从13639400（15%）增加到15666300（15.7%），但这一增长未达到统计学显著性（p = 0.17）。在这五年期间，老年急诊患者的住院率从32%上升到46%（p<0.01）。这意味着1995年老年患者住院人数超过700万。在这五年期间，老年患者入住重症监护病房（ICU）的比例从7%降至6%（p = 0.56），而非老年患者这两年的比例均为1.3%。1990年，30%的老年急诊患者通过救护车送达，1995年这一比例为33%（p = 0.02）。根据1995年的数据，老年人占通过救护车送达患者的39%[优势比（OR）4.75，95%置信区间（CI）= 4.71至4.79]，占所有住院患者的43%（OR 6.59，95% CI = 6.54至6.64），占ICU住院患者的47%（OR 5.00，95% CI = 4.91至5.09）。1990年相应的数据分别为4.4、5.6和5.5。
从1990年到1995年，急诊科就诊总人次增加。老年患者的增长幅度略大。老年患者使用救护车服务的比例以及住院率也不成比例地增加。ICU住院的总体比例稳定，但老年患者实际上略有下降。在这些变化中，只有老年患者住院率的增加具有统计学显著性。
