The Recidivism Characteristics of an Emergency Department Observation Unit
The Recidivism Characteristics of an Emergency Department Observation Unit
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DOI：
10.1016/j.annemergmed.2010.02.012
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发表时间：
2010-07-01
影响因子：
6.2
通讯作者：
Clark, Carol
中科院分区：
文献类型：
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作者：
Ross, Michael A.;Hemphill, Robin R.;Clark, Carol
研究目的：描述成人急诊科(ED)观察单元人群的再发特征，并确定不同人口学或临床特征的再犯罪率是否不同。方法：这项前瞻性观察队列研究回顾了所有在连续6个月内因出院后14天内因非计划ED就诊或直接住院于研究医院或邻近附属医院的出院ED观察单元患者。从医院数据库中确定年龄、性别、最初的ED观察单元诊断、ED观察单元的住院时间和回访倾向，并通过图表复习进行确认。结果：共有55,727人次急诊，其中4,348人进入急诊观察室，其中80.7%(3,509人)已出院。有或没有回访的患者在年龄(56.9岁[标准差(SD)19.5年])、男性患者百分比(40.0%)或首次ED观察单位住院时间(15.0小时[SD 6.0小时])方面相似。在出院的ED观察单元患者中，有375例(10.8%)有回访，其中277例(7.9%)有关系。在回访中，86.3%的患者仅回访1次，11.6%的患者回访2次，2.1%的患者回访3次或以上；4.2%的患者回访发生在附属医院。首次复诊时间集中在相关就诊的第一周内，平均复诊时间为4.5天(SD 3.9天)。在回访时，40.2%的患者在急诊室接受治疗并出院，36.2%的患者在急诊室接受治疗并入院，14.4%的患者在急诊室接受治疗后再到急诊室观察并出院，12.3%的患者直接入院，2.5%的患者先在急诊室治疗后再在急诊室观察并入院。在常见疾病中，头痛(16.1%)、背痛(13.8%)和腹痛(12.7%)的相关回诊率最高，胸痛(3.6%)最低。作为一个整体，治疗方案，特别是疼痛状况，相关的回访率显著高于诊断方案(10.8%对5.1%)。结论：在急诊观察单元就诊后返回的患者在年龄、性别或初始住院时间方面与未返回的患者相似。然而，ED观察单元的再犯罪率因观察类别的不同而有所不同，痛苦的情况显示出最高的再犯罪率。访问数/每百万人：Reach for[Ann Emerg2010；56：34-41。]
Study objective: We describe the recidivism characteristics of an adult emergency department (ED) observation unit population and determine whether rates differ according to demographic or clinical features.Methods: This prospective observational cohort study of a protocol-driven ED observation unit reviewed all discharged ED observation unit patients who returned within 14 days of discharge for an unscheduled ED visit or direct inpatient admission to the study hospital, or a proximate affiliated hospital, during 6 consecutive months. Age, sex, initial ED observation unit diagnosis, ED observation unit length of stay, and return visit disposition were determined from hospital databases and confirmed by chart review. All return visits were classified as related or unrelated to the index visit.Results: There were 55,727 ED visits, with 4,348 patients admitted to the ED observation unit, of whom 80.7% (3,509) were discharged. Patients with or without a return visit were similar in terms of age (56.9 years [standard deviation (SD) 19.5 years]), percentage of male patients (40.0%), or initial ED observation unit length of stay (15.0 hours [SD 6.0 hours]). Of discharged ED observation unit patients, 375 (10.8%) had a return visit, of which 277 (7.9%) were related. Of return visits, 86.3% of patients had only 1 return visit, 11.6% had 2, and 2.1% had 3 or more; 4.2% of returns occurred at an affiliated hospital. Time to first return visit was clustered within the first week for related visits, with a mean time to return of 4.5 days (SD 3.9 days). On return visit, 40.2% of patients were treated and discharged from the ED, 36.2% were treated in the ED and admitted, 14.4% were treated in the ED and then the ED observation unit and discharged home, 12.3% were directly admitted to the hospital, and 2.5% were treated in the ED and then the ED observation unit and admitted. Among common conditions, related return visit rates were highest for headache (16.1%), back pain (13.8%), and abdominal pain (12.7%) and lowest for chest pain (3.6%). As a group, therapeutic protocols, and specifically painful conditions, had significantly higher related return visit rates than diagnostic protocols (10.8% versus 5.1%).Conclusion: Patients who return after an ED observation unit visit are similar to patients who do not return in terms of age, sex, or initial length of stay. However, ED observation unit recidivism rates do differ according to observation category, with painful conditions showing the highest recidivism rates. [Ann Emerg Med. 2010;56:34-41.]