Association of Age, Systolic Blood Pressure, and Heart Rate with Adult Morbidity and Mortality after Urgent Care Visits.
Association of Age, Systolic Blood Pressure, and Heart Rate with Adult Morbidity and Mortality after Urgent Care Visits.
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DOI：
10.5811/westjem.2016.6.30353
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发表时间：
2016-09
期刊：
影响因子：
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通讯作者：
Allen T
中科院分区：
文献类型：
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作者：
Hart J;Woodruff M;Joy E;Dalto J;Snow G;Srivastava R;Isaacson B;Allen T
几乎没有数据可以帮助紧急护理（UC）临床医生预测发病率和死亡率风险。年龄，收缩压（SBP）和心率（HR）很容易获得，并已在其他环境中用于预测短期恶化风险。我们假设年龄增长、SBP、HR和UC患者的短期健康结局之间存在相关性。我们收集了2008-2013年间Intermountain Healthcare系统中28家UC诊所和22家医院的回顾性数据。如果有唯一的UC访视和HR或SBP数据，则纳入成人患者（≥18岁）。评估了UC访视后的三个终点：3天内急诊科（艾德）访视、3天内住院和7天内死亡。我们使用二项似然局部回归分析了年龄、SBP、HR和终点之间的相关性。从以前公布的全国调查中选择了五个年龄组。确定每个年龄组的生命体征（VS）分布，并将集中趋势与先前发表的标准（SBP为90- 120 mmHg，HR为60- 100 bpm）进行比较。共有1，720，207例患者（714，339例独特患者）符合入选标准; 51，446例患者（2.99%）在3天内接受了艾德访视; 12，397例患者（0.72%）在3天内住院; 302例患者（0.02%）在UC访视后7天内死亡。心率和SBP结合高龄预测UC访视后艾德访视（p<0.0001）和住院（p<0.0001）的概率。观察到年龄增长与死亡（p<0.0001）和VS与死亡（p<0.0001）之间存在显著相关性。血压较低或心率较高的老年患者的风险比值比最高。观察到的所有年龄组的血压分布均高于已发表的正常范围。在UC寻求治疗的成人中，HR和SBP与艾德就诊和住院的可能性之间的相关性随着年龄的增长而更加明显。UC访视后的死亡与年龄增长或评价的VS的相关性更有限。老年患者中SBP低于100-110 mmHg的风险迅速增加，表明可能需要重新定义UC门诊治疗患者的SBP可接受正常范围。
Little data exists to help urgent care (UC) clinicians predict morbidity and mortality risk. Age, systolic blood pressure (SBP), and heart rate (HR) are easily obtainable and have been used in other settings to predict short-term risk of deterioration. We hypothesized that there is a relationship between advancing age, SBP, HR, and short-term health outcomes in the UC setting. We collected retrospective data from 28 UC clinics and 22 hospitals in the Intermountain Healthcare system between years 2008–2013. Adult patients (≥18 years) were included if they had a unique UC visit and HR or SBP data. Three endpoints following UC visit were assessed: emergency department (ED) visit within three days, hospitalization within three days, and death within seven days. We analyzed associations between age, SBP, HR and endpoints using local regression with a binomial likelihood. Five age groups were chosen from previously published national surveys. Vital sign (VS) distributions were determined for each age group, and the central tendency was compared against previously published norms (90–120mmHg for SBP and 60–100bpm for HR.) A total of 1,720,207 encounters (714,339 unique patients) met the inclusion criteria; 51,446 encounters (2.99%) had ED visit within three days; 12,397 (0.72%) experienced hospitalization within three days; 302 (0.02%) died within seven days of UC visit. Heart rate and SBP combined with advanced age predicted the probability of ED visit (p<0.0001) and hospitalization (p<0.0001) following UC visit. Significant associations between advancing age and death (p<0.0001), and VS and death (p<0.0001) were observed. Odds ratios of risk were highest for elderly patients with lower SBP or higher HR. Observed distributions of SBP were higher than published normal ranges for all age groups. Among adults seeking care in the UC, associations between HR and SBP and likelihood of ED visits and hospitalization were more pronounced with advancing age. Death following UC visit had a more limited association with advancing age or the VS evaluated. Rapidly increasing risk below SBP of 100–110 mmHg in older patients suggests that accepted normal ranges for SBP may need to be redefined for patients treated in the UC clinic.