Cerebrovascular disease hospitalizations following emergency department headache visits: A nested case-control study.
Cerebrovascular disease hospitalizations following emergency department headache visits: A nested case-control study.
复制标题
DOI：
10.1111/acem.14353
复制
发表时间：
2022-01
期刊：
影响因子：
--
通讯作者：
Newman-Toker DE
中科院分区：
文献类型：
--
作者：
Liberman AL;Hassoon A;Fanai M;Badihian S;Rupani H;Peterson SM;Sebestyen K;Wang Z;Zhu Y;Lipton RB;Newman-Toker DE
患者脑血管疾病（CVD）的延迟诊断可能会导致重大伤害。如果在CVD住院前的急诊科（艾德）就诊时可以识别诊断过程失败，则可以开发提高诊断准确性的干预措施。我们使用2015年10月1日至2018年3月31日从单一医疗中心出院的良性头痛诊断的成人艾德患者队列进行了一项巢式病例对照研究。使用区域健康信息交换确定了首次艾德访视1年内因CVD住院的患者。使用患者的年龄和访视日期，将随后CVD住院的患者（病例）与随后未住院的患者（对照组）进行个体匹配。通过详细的病历审查评估人口统计学、临床和艾德过程特征。使用McNemar分类检验和连续变量配对t检验，统计学显著性设定为≤0.05。在9，157例艾德头痛就诊患者中，57例（0.6%; 95% CI：0.5-0.8）随后因CVD住院。从艾德访视到住院的中位时间为107天。在25例患者（43.9%; 25/57）中，CVD住院和指数艾德访视在不同的医院进行。最终研究分析包括53例病例和53例匹配对照。病例组和对照组具有相似的基线人口统计学和头痛特征。首次艾德访视前，病例更常有卒中史（32.1% vs. 13.2%，p=0.02）和神经外科史（13.2% vs. 1.9%，p=0.03）。更多病例记录的神经系统检查项目<2项（30.2% vs. 11.3%，p=0.03）。我们发现，0.6%的艾德头痛患者随后因心血管疾病住院，通常是在另一个医疗中心。在既往有卒中或神经外科手术史的患者中，因头痛就诊的艾德可能是预防CVD的重要机会。病例中记录的神经系统检查较差，这可能代表了艾德过程改进的机会。
Delayed diagnosis of cerebrovascular disease (CVD) among patients can result in substantial harm. If diagnostic process failures can be identified at Emergency Department (ED) visits that precede CVD hospitalization, interventions to improve diagnostic accuracy can be developed. We conducted a nested case-control study using a cohort of adult ED patients discharged from a single medical center with a benign headache diagnosis from 10/1/2015-3/31/2018. Hospitalizations for CVD within 1 year of index ED visit were identified using a regional health information exchange. Patients with subsequent CVD hospitalization (cases) were individually matched to patients without subsequent hospitalization (controls) using patient’s age and visit date. Demographic, clinical, and ED processes characteristics were assessed via detailed chart review. McNemar’s test for categorical and paired t-test for continuous variables were used with statistical significance set at ≤0.05. Of the 9,157 patients with ED headache visits, 57 (0.6%; 95% CI:0.5-0.8) had a subsequent CVD hospitalization. Median time from ED visit to hospitalization was 107 days. In twenty-five patients (43.9%; 25/57) the CVD hospitalization and the index ED visit were at different hospitals. Fifty-three cases and 53 matched controls were included in the final study analysis. Cases and controls had similar baseline demographic and headache characteristics. Cases more often had a history of stroke (32.1% vs. 13.2%, p=0.02) and neurosurgery (13.2% vs. 1.9%, p=0.03) prior to the index ED visit. Cases more often had <2 components of the neurological exam documented (30.2% vs. 11.3%, p=0.03). We found that 0.6% of patients with an ED headache visit had subsequent CVD hospitalization, often at another medical center. ED visits for headache complaints among patients with prior stroke or neurosurgical procedures may be important opportunities for CVD prevention. Documented neurological examinations were poorer among cases, which may represent an opportunity for ED process improvement.
登录
查看更多内容
影响因子：
5.4
作者：
Calder L;Pozgay A;Riff S;Rothwell D;Youngson E;Mojaverian N;Cwinn A;Forster A
通讯作者：
Forster A
影响因子：
3.5
作者：
Singh, Hardeep;Khanna, Arushi;Meyer, Ashley N. D.
通讯作者：
Meyer, Ashley N. D.
影响因子：
3.5
作者：
Liberman, Ava L.;Wang, Cuiling;Lipton, Richard B.
通讯作者：
Lipton, Richard B.
影响因子：
5
作者：
Buse, Dawn C.;Loder, Elizabeth W.;Lipton, Richard B.
通讯作者：
Lipton, Richard B.
影响因子：
9.9
作者：
Richoz, Benjamin;Hugli, Olivier;Michel, Patrik
通讯作者：
Michel, Patrik