Resource utilisation among patients transferred for intracerebral haemorrhage.
Resource utilisation among patients transferred for intracerebral haemorrhage.
复制标题
脑出血转院患者的资源利用。
DOI：
10.1136/svn-2019-000255
复制
发表时间：
2019
影响因子：
5.9
通讯作者：
Goldstein,JoshuaN
中科院分区：
文献类型：
--
作者：
Zachrison,KoriSauser;Aaronson,Emily;Mahmood,Sadiqa;Rosand,Jonathan;Viswanathan,Anand;Schwamm,LeeH;Goldstein,JoshuaN
背景脑出血（ICH）患者经常在医院之间转院以获得更高水平的护理。我们的目的是确定与单一学术医院收治的 ICH 患者资源利用相关的因素。方法我们使用前瞻性收集的 2005 年 1 月 1 日至 2015 年 12 月 31 日期间在城市学术医院连续收治的原发性 ICH 患者的登记资料。主要结局是使用重症监护病房 (ICU) 入住或手术干预。 Logistic 回归检查了与结果相关的因素，控制了年龄、性别、格拉斯哥昏迷评分 (GCS) 和 ICH 评分。结果在 2008 名患者中，887 名 (44.2%) 接受了 ICU 住院或手术干预。这些患者年龄较小（71 岁 vs 74 岁，p<0.001），白人较少见（83.9% vs 89.3%，p<0.001），基线 GCS 较低（12 vs 14，p<0.001），且脑室内出血更常见（58.6% vs 43.4%，p<0.001）。与 ICU 住院或手术干预独立相关的因素为年龄 >65 岁（OR 0.38，95%CI 0.21 至 0.69）、GCS <15（1.23，95%CI 1.01 至 1.52）和 ICH 评分 >0（OR 2.23，95%CI 1.70 至 2.91）。原发性 ICH 患者队列中，GCS 为 15 且 ICH 评分为 0 与 ICU 或干预使用频率较低相关。这些结果应该在更大的样本中进行验证，但对于考虑哪些 ICH 患者可以安全地留在转诊机构的医院来说可能很有价值。
BackgroundPatients with intracerebral haemorrhage (ICH) are frequently transferred between hospitals for higher level of care. We aimed to identify factors associated with resource utilisation among patients with ICH admitted to a single academic hospital.MethodsWe used a prospectively collected registry of consecutive patients with primary ICH at an urban academic hospital between 1 January 2005 and 31 December 2015. The primary outcome was use of either intensive care unit (ICU) admission or surgical intervention. Logistic regression examined factors associated with the outcome, controlling for age, sex, Glasgow coma score (GCS) and ICH score.ResultsOf the 2008 patients included, 887 (44.2%) received ICU stay or surgical intervention. These patients were younger (71 vs 74 years, p<0.001), less often white (83.9% vs 89.3%, p<0.001), had lower baseline GCS (12 vs 14, p<0.001) and more frequently had intraventricular haemorrhage (58.6% vs 43.4%, p<0.001). Factors independently associated with ICU stay or surgical intervention were age >65 years (OR 0.38, 95% CI 0.21 to 0.69), GCS <15 (1.23, 95% CI 1.01 to 1.52) and ICH score >0 (OR 2.23, 95% CI 1.70 to 2.91).ConclusionAmong this cohort of primary patients with ICH, GCS of 15 and ICH score of 0 were associated with less frequent use of ICU or intervention. These results should be validated in a larger sample but may be valuable for hospitals considering which patients with ICH could safely remain at the referring facility.