Is ED disposition associated with intracerebral hemorrhage mortality?
Is ED disposition associated with intracerebral hemorrhage mortality?
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DOI：
10.1016/j.ajem.2009.10.016
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发表时间：
2011-05-01
影响因子：
3.6
通讯作者：
Flaherty, Matthew L.
中科院分区：
文献类型：
--
作者：
Adeoye, Opeolu;Haverbusch, Mary;Flaherty, Matthew L.
背景：早期恶化在脑出血（ICH）中很常见。三级医疗中心的治疗与较低的脑出血死亡率相关。指南建议无论最初的前景如何，都要进行 24 小时积极护理。我们研究了最初在非三级急诊科 (ED) 就诊的 ICH 患者转至三级中心的频率和相关因素。我们还使用已发表的 ICH 短期死亡率预测因子将观察到的转移和非转移患者的预期死亡率进行了比较。方法：确定了居住在 5 个县地区并于 2005 年因非创伤性 ICH 就诊于非三级急诊室的成年患者。确定脑出血评分和ICH分级量表(ICH-GS)。在 16 家当地医院中，有 2 家被指定为三级护理中心。使用逻辑回归来评估与转移相关的因素。结果：在 205 名就诊于非三级急诊室的 ICH 患者中，80 名 (39.0%) 被转移到三级中心。在多元回归中，更好的基线函数（改良Rankin量表0-2与3-5；比值比，0.42，95%置信区间，0.21-0.85，P = .016）和黑人种族（比值比，2.28，95%置信区间1.01-5.12，P = .046）与转移相关。在非转移患者中观察到 30 天死亡率较高的趋势（32.5% 对比 45.6%，P = .06）。 ICH-GS 高估了所有患者的死亡率，而 ICH 评分充分预测了死亡率。结论：我们发现转移患者和非转移患者之间的死亡率没有显着差异，但非转移患者死亡率较高的趋势表明，有必要进一步评估 ICH 患者的 ED 处置决策。已发布的工具可能会高估预期的 ICH 死亡率。 (C) 2011 Elsevier Inc. 保留所有权利。
Background: Early deterioration is common in intracerebral hemorrhage (ICH). Treatment at tertiary care centers has been associated with lower ICH mortality. Guidelines recommend aggressive care for 24 hours irrespective of the initial outlook. We examined the frequency of and factors associated with transfer to tertiary centers in ICH patients who initially presented at nontertiary emergency departments (EDs). We also compared observed with expected mortality in transferred and nontransferred patients using published short-term mortality predictors for ICH.Methods: Adult patients who resided in a 5-county region and presented to nontertiary EDs with nontraumatic ICH in 2005 were identified. Intracerebral hemorrhage score and ICH Grading Scale (ICH-GS) were determined. Of 16 local hospitals, 2 were designated tertiary care centers. Logistic regression was used to assess factors associated with transfer.Results: Of 205 ICH patients who presented to nontertiary EDs, 80 (39.0%) were transferred to a tertiary center. In multivariate regression, better baseline function (modified Rankin scale 0-2 versus 3-5; odds ratio, 0.42, 95% confidence interval, 0.21-0.85, P = .016) and black race (odds ratio, 2.28, 95% confidence interval 1.01-5.12, P = .046) were associated with transfer. A trend toward higher 30-day mortality was observed in nontransferred patients (32.5% versus 45.6%, P = .06). The ICH-GS overestimated mortality for all patients, while the ICH Score adequately predicted mortality.Conclusions: We found no significant difference in mortality between transferred and nontransferred patients, but the trend toward higher mortality in nontransferred patients suggests that further evaluation of ED disposition decisions for ICH patients is warranted. Expected ICH mortality may be overestimated by published tools. (C) 2011 Elsevier Inc. All rights reserved.