Pediatric Emergency Department Crowding Is Associated With a Lower Likelihood of Hospital Admission
Pediatric Emergency Department Crowding Is Associated With a Lower Likelihood of Hospital Admission
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DOI：
10.1111/j.1553-2712.2012.01390.x
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发表时间：
2012-07-01
影响因子：
4.4
通讯作者：
Bachur, Richard G.
中科院分区：
文献类型：
--
作者：
Michelson, Kenneth A.;Monuteaux, Michael C.;Bachur, Richard G.
学术急诊医学2012; 19：816820（c）2012年由学术急诊医学学会摘要目标：急诊科（艾德）拥挤可能会影响处置决策。目的是测量艾德拥挤对入院概率和出院后回访艾德的影响。方法：作者研究了一个大型儿科艾德超过40个月的历史队列。根据艾德入住率（患者与床位的比率），每位患者在到达时都被分配了一个分数。患者按入住率分为五分之一。将每个五分之一的入院比例与最不拥挤的五分之一进行比较，调整了急性，住院率和到达时间。对48小时内到艾德的回访进行了相同的分析。对哮喘和胃肠炎和/或脱水患者亚组重复分析。结果：从40个月的历史数据中，分析了198，778次访问。整个队列中入院的调整优势比（aOR）为0.85（95%置信区间[CI] = 0.81至0.89），比较最高和最低拥挤五分位数（入住率分别> 1.17和< 0.54）。对于哮喘患者，aOR = 0.93（95% CI = 0.72 - 1.20），对于胃肠炎患者，aOR = 0.87（95% CI = 0.65 - 1.17）。对于所有患者，将最高拥挤五分位数与最低拥挤五分位数进行比较的回访aOR为aOR = 0.87（95% CI = 0.79至0.97），对于哮喘患者，aOR = 1.52（95% CI = 0.95至2.46），对于胃肠炎患者，aOR = 0.83（95% CI = 0.54至1.28）。结论：增加艾德拥挤与入院的可能性降低和48小时内回访的频率降低有关。
ACADEMIC EMERGENCY MEDICINE 2012; 19:816820 (c) 2012 by the Society for Academic Emergency Medicine Abstract Objectives: Emergency department (ED) crowding may affect disposition decision-making. The objective was to measure the effect of ED crowding on probability of admission and return visit to the ED after discharge. Methods: The authors studied a historical cohort at a large pediatric ED over 40 months. Each patient was assigned a score on arrival based on the ED occupancy rate (the ratio of patients to beds). Patients were divided into quintiles by occupancy rate. The proportion admitted for each quintile was compared to the least crowded quintile adjusting for acuity, hospital occupancy, and time of arrival. The same analysis was performed for return visits to the ED within 48 hours. The analyses were repeated for the subsets of patients with asthma and with gastroenteritis and/or dehydration. Results: From the 40 months of historical data, 198,778 visits were analyzed. The adjusted odds ratio (aOR) for admission among the whole cohort was 0.85 (95% confidence interval [CI] = 0.81 to 0.89) comparing the highest to the lowest crowding quintiles (occupancy rate > 1.17 and < 0.54, respectively). For asthma patients, aOR = 0.93 (95% CI = 0.72 to 1.20), and for gastroenteritis patients, aOR = 0.87 (95% CI = 0.65 to 1.17). The aOR of return visits comparing the highest to the lowest crowding quintiles for all patients was aOR = 0.87 (95% CI = 0.79 to 0.97), for asthma patients was aOR = 1.52 (95% CI = 0.95 to 2.46), and for gastroenteritis patients was aOR = 0.83 (95% CI = 0.54 to 1.28). Conclusions: Increasing ED crowding is associated with a lower likelihood of hospital admission and lower frequency of return visits within 48 hours.