Racial and Sex Differences in Emergency Department Triage Assessment and Test Ordering for Chest Pain, 1997-2006
Racial and Sex Differences in Emergency Department Triage Assessment and Test Ordering for Chest Pain, 1997-2006
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DOI：
10.1111/j.1553-2712.2010.00823.x
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发表时间：
2010-08-01
影响因子：
4.4
通讯作者：
Green, Alexander R.
中科院分区：
文献类型：
--
作者：
Lopez, Lenny;Wilper, Andrew P.;Green, Alexander R.
目的：本研究评估是否存在社会人口统计学差异分诊分配，以及这些差异是否影响初始诊断测试在急诊科（艾德）的患者表现为chest pain.Methods：一个全国代表性的艾德数据样本的所有成年人（>= 18岁）从全国医院门诊健康护理调查的ED为1997-2006年。加权Logistic回归被用来检查种族和症状，分流分配，测试排序，调整病人和医院的characteristics.Results之间的关联：在10年，估计有78万访问艾德提出了胸痛的投诉。在胸痛患者中，非裔美国人（比值比[OR] = 0.70; 99%置信区间[CI] = 0.53 - 0.92），西班牙裔（OR = 0.74; 99%CI = 0.51 ~ 0.99），医疗补助患者（OR = 0.72; 99%CI = 0.54 ~ 0.94），而无保险的患者（OR = 0.65; 99%CI = 0.51 ~ 0.84）不太可能被紧急分诊。非裔美国人（OR = 0.86; 99% CI = 0.70至0.99）、医疗补助患者（OR = 0.70; 99% CI = 0.55至0.88）和未投保患者（OR = 0.70; 99% CI = 0.55至0.89）不太可能接受心电图（ECG）检查。非裔美国人（OR = 0.69; 99%CI = 0.49至0.97）、医疗补助患者（OR = 0.67; 99%CI = 0.47至0.95）和未投保患者（OR = 0.66; 99%CI = 0.44至0.96）订购心肌酶的可能性较小。同样，非洲裔美国人和西班牙裔人不太可能有心脏监测和脉搏血氧饱和度下令，医疗补助和未投保的患者不太可能有心脏monitoredordered.Conclusions：持续的种族，性别和保险差异分流分类和基本的心脏测试存在。消除分诊差异可能会影响“下游”临床护理，并有助于消除观察到的心脏结局差异。
P>Objectives:This study assessed whether sociodemographic differences exist in triage assignment and whether these differences affect initial diagnostic testing in the emergency department (ED) for patients presenting with chest pain.Methods:A nationally representative ED data sample for all adults (>= 18 years) was obtained from the National Hospital Ambulatory Health Care Survey of EDs for 1997-2006. Weighted logistic regression was used to examine the associations between race and presenting symptom, triage assignment, and test ordering, adjusting for patient and hospital characteristics.Results:Over 10 years, an estimated 78 million visits to the ED presented with a complaint of chest pain. Of those presenting with chest pain, African Americans (odds ratio [OR] = 0.70; 99% confidence interval [CI] = 0.53 to 0.92), Hispanics (OR = 0.74; 99% CI = 0.51to 0.99), Medicaid patients (OR = 0.72; 99% CI = 0.54 to 0.94), and uninsured patients (OR = 0.65; 99% CI = 0.51 to 0.84) were less likely to be triaged emergently. African Americans (OR = 0.86; 99% CI = 0.70 to 0.99), Medicaid patients (OR = 0.70; 99% CI = 0.55 to 0.88), and uninsured patients (OR = 0.70; 99% CI = 0.55 to 0.89) were less likely to have an electrocardiogram (ECG) ordered. African Americans (OR = 0.69; 99% CI = 0.49 to 0.97), Medicaid patients (OR = 0.67; 99% CI = 0.47 to 0.95), and uninsured patients (OR = 0.66; 99% CI = 0.44 to 0.96) were less likely to have cardiac enzymes ordered. Similarly, African Americans and Hispanics were less likely to have a cardiac monitor and pulse oximetry ordered, and Medicaid and uninsured patients were less likely to have a cardiac monitor ordered.Conclusions:Persistent racial, sex, and insurance differences in triage categorization and basic cardiac testing exist. Eliminating triage disparities may affect "downstream" clinical care and help eliminate observed disparities in cardiac outcomes.