The impact of pediatric emergency department crowding on patient and health care system outcomes: a multicentre cohort study
The impact of pediatric emergency department crowding on patient and health care system outcomes: a multicentre cohort study
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DOI：
10.1503/cmaj.181426
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发表时间：
2019-06-10
影响因子：
14.6
通讯作者：
Guttmann, Astrid
中科院分区：
文献类型：
--
作者：
Quynh Doan;Wong, Hubert;Guttmann, Astrid
背景技术背景：急诊室过度拥挤与主要是成人队列的急诊室出院后住院和死亡率增加有关。本研究的目的是评估拥挤和在儿科急诊科就诊的儿童中出现几种不良结局的几率之间的关系。方法：我们进行了一项回顾性队列研究，涉及2010年至2014年期间在4个省的8个加拿大儿科急诊科就诊的所有儿童。我们使用混合效应logistic回归模型分析了每次索引访视的平均科室住院时间与急诊科出院后7天内住院或14天内死亡之间的相关性，以及索引访视和7天内回访时的住院时间。研究结果：在5年期间，各研究中心共进行了1 931 465次索引访视，索引访视住院或中位住院时间变化不大。在各省，出院后7天内住院和14天死亡率较低（分别为0.8%-1.5%和< 10/10万次就诊），其与平均科室住院时间的相关性因分诊类别和不同地点而异，但不显著。索引访视时入院的几率增加，在加拿大分类和敏锐度量表（CTAS）评分为1-2分的访视中（比值比[OR]范围为1.01 - 1.08）和在某些研究中心索引访视时出院的CTAS评分为4-5分的患者的回访中（OR范围为1.00 - 1.06），科室拥挤增加。释义：急诊室拥挤与急诊室就诊后7天内住院或儿童死亡率无显著相关性。然而，这与病情最严重的儿童在索引访问时的住院率增加以及病情较轻的儿童到急诊科的回访有关。
BACKGROUND: Emergency department overcrowding has been associated with increased odds of hospital admission and mortality after discharge from the emergency department in predominantly adult cohorts. The objective of this study was to evaluate the association between crowding and the odds of several adverse outcomes among children seen at a pediatric emergency department. METHODS: We conducted a retrospective cohort study involving all children visiting 8 Canadian pediatric emergency departments across 4 provinces between 2010 and 2014. We analyzed the association between mean departmental length of stay for each index visit and hospital admission within 7 days or death within 14 days of emergency department discharge, as well as hospital admission at index visit and return visits within 7 days, using mixed-effects logistic regression modelling. RESULTS: A total of 1 931 465 index visits occurred across study sites over the 5-year period, with little variation in index visit hospital admission or median length of stay. Hospital admission within 7 days of discharge and 14-day mortality were low across provinces (0.8%-1.5% and < 10 per 100 000 visits, respectively), and their association with mean departmental length of stay varied by triage categories and across sites but was not significant. There were increased odds of hospital admission at the index visit with increasing departmental crowding among visits triaged to Canadian Triage and Acuity Scale (CTAS) score 1-2 (odds ratios [ORs] ranged from 1.01 to 1.08) and return visits among patients with a CTAS score of 4-5 discharged at the index visit at some sites (ORs ranged from 1.00 to 1.06). INTERPRETATION: Emergency department crowding was not significantly associated with hospital admission within 7 days of the emergency department visit or mortality in children. However, it was associated with increased hospital admission at the index visit for the sickest children, and with return visits to the emergency department for those less sick.