Risk factors for hyperthermia mortality among emergency department patients.
Risk factors for hyperthermia mortality among emergency department patients.
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DOI：
10.1016/j.annepidem.2021.09.009
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发表时间：
2021-12
影响因子：
5.6
通讯作者：
Goldman-Mellor S
中科院分区：
文献类型：
--
作者：
Hall C;Ha S;Yen IH;Goldman-Mellor S
本研究探讨急诊科病人，一个易受伤害的人群，因热相关死亡的危险因素。这项匹配的病例对照研究使用了全州范围内的、纵向关联的急诊科（ED）数据和加州的死亡记录。病例包括加州居民（≥18岁），他们在研究期间（2009-2012年）到州许可的急诊科就诊并死于热疗。对于每个病例，随机选择多达5名ED患者作为活对照，并根据性别和年龄进行匹配。评估患者的人口学特征和ED使用史，包括酒精使用、药物使用、精神疾病、心脏相关疾病、慢性呼吸系统疾病、神经退行性疾病和脑血管疾病与热疗死亡率的关系。使用多变量条件logistic回归模型，与对照组相比，热疗死亡病例先前因饮酒而使用ED的几率更高（OR=11.16, 95% CI=3.87, 32.17）。在最近一次急诊科就诊时，病例也比对照组更有可能有医疗保险（OR=5.80, 95% CI=1.70, 15.15）或自费（OR=5.39, 95% CI=1.73, 16.79）。出现酒精问题的ED患者可能面临更高的热疗死亡率风险。为了帮助降低与热相关的死亡率，急诊科应该考虑针对易受热暴露的患者进行干预。
This study examines risk factors for heat-related mortality due to hyperthermia in emergency department patients, a vulnerable population. This matched case-control study used statewide, longitudinally linked emergency department (ED) data and death records from California. Cases comprised California residents (≥18 years) who presented to a state-licensed ED and died of hyperthermia during the study period (2009–2012). For each case, up to five ED patients were randomly selected as live controls and matched on sex and age. Patients’ demographic characteristics and history of ED utilization for alcohol use, drug use, psychiatric disorders, heart-related conditions, chronic respiratory disease, neurodegenerative disorders, and cerebrovascular disease were assessed in relationship to hyperthermia mortality. Using multivariate conditional logistic regression models, hyperthermia mortality cases had higher odds of prior ED utilization for alcohol use (OR=11.16, 95% CI=3.87, 32.17) compared to controls. Cases were also more likely than controls to have Medicare insurance (OR=5.80, 95% CI=1.70, 15.15) or self-pay (OR=5.39, 95% CI=1.73, 16.79), at their most recent ED visit. ED patients presenting with alcohol problems may face increased risk of hyperthermia mortality. To help reduce heat-related mortality, EDs should consider interventions that target patients vulnerable to heat exposure.
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