Comparing emergency department use among individuals with varying levels of cognitive impairment.
Comparing emergency department use among individuals with varying levels of cognitive impairment.
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DOI：
10.1186/s12877-022-03093-5
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发表时间：
2022-05-02
期刊：
影响因子：
4.1
通讯作者：
Patterson, Brian W.
中科院分区：
文献类型：
--
作者：
Green, Rebecca K.;Shah, Manish N.;Clark, Lindsay R.;Batt, Robert J.;Chin, Nathaniel A.;Patterson, Brian W.
随着人口老龄化，阿尔茨海默病及相关痴呆（ADRD）在急诊科（ED）就诊的患者中越来越常见。本研究比较了一组具有明确认知表现（认知完好、轻度认知障碍（MCI）和ADRD）的个体使用急诊科的频率。
我们对2014 - 2016年在四个基于卫生系统的多学科记忆诊所接受评估的讲英语的社区居住个体进行了一项回顾性队列研究。我们通过病历回顾以及与电子健康记录数据的关联，获取了人口统计学和临床数据，包括神经心理学测试结果。我们描述了认知评估前后一年内（前6个月和后6个月）使用急诊科的频率和次数，并使用双变量和多变量方法比较了三组之间使用急诊科的情况。
在779名符合条件的患者中，89名被诊断为认知完好，372名被诊断为MCI，318名被诊断为ADRD。每年使用过急诊科的受试者比例并没有随着认知障碍的加重而显著增加：认知完好者为16.9%，MCI患者为26.1%，ADRD患者为28.9%（p = 0.072）。平均就诊次数的增加情况类似：认知完好者为0.27次（标准差0.72），MCI患者为0.41次（标准差0.91），ADRD患者为0.55次（标准差1.25）（p = 0.059）。多变量逻辑回归结果显示，MCI患者（优势比（OR）1.62；置信区间 = 0.87 - 3.00）和ADRD患者（OR 1.84；置信区间 = 0.98 - 3.46）在使用急诊科方面与认知完好的成年人没有显著差异。多变量负二项回归发现，与认知完好的个体相比，MCI患者（发病率比（IRR）1.38；置信区间 = 0.79 - 2.41）和ADRD患者（IRR 1.76，置信区间 = 1.00 - 3.10）有增加的急诊就诊风险，但差异不显著。
尽管在来自一个卫生系统的这个小样本中，使用急诊科的情况没有显著差异，但我们的估计与其他已发表的研究结果相当。结果表明，与认知完好的成年人相比，MCI或ADRD成年人有更高利用率的趋势。我们必须在其他环境中证实我们的发现，以便更好地了解如何为MCI和ADRD患者优化急性疾病护理系统。
网络版包含补充材料，可在10.1186/s12877 - 022 - 03093 - 5获取。
As the population ages, Alzheimer’s disease and related dementias (ADRD) are becoming increasingly common in patients presenting to the emergency department (ED). This study compares the frequency of ED use among a cohort of individuals with well-defined cognitive performance (cognitively intact, mild cognitive impairment (MCI), and ADRD). We performed a retrospective cohort study of English-speaking, community-dwelling individuals evaluated at four health system-based multidisciplinary memory clinics from 2014–2016. We obtained demographic and clinical data, including neuropsychological testing results, through chart review and linkage to electronic health record data. We characterized the frequency and quantity of ED use within one year (6 months before and after) of cognitive evaluation and compared ED use between the three groups using bivariate and multivariate approaches. Of the 779 eligible patients, 89 were diagnosed as cognitively intact, 372 as MCI, and 318 as ADRD. The proportion of subjects with any annual ED use did not increase significantly with greater cognitive impairment: cognitively intact (16.9%), MCI (26.1%), and ADRD (28.9%) (p = 0.072). Average number of ED visits increased similarly: cognitively intact (0.27, SD 0.72), MCI (0.41, SD 0.91), and ADRD (0.55, SD 1.25) (p = 0.059). Multivariate logistic regression results showed that patients with MCI (odds ratio (OR) 1.62; CI = 0.87–3.00) and ADRD (OR 1.84; CI = 0.98–3.46) did not significantly differ from cognitively intact adults in any ED use. Multivariate negative binomial regression found patients with MCI (incidence rate ratio (IRR) 1.38; CI = 0.79–2.41) and ADRD (IRR 1.76, CI = 1.00–3.10) had elevated but non-significant risk of an ED visit compared to cognitively intact individuals. Though there was no significant difference in ED use in this small sample from one health system, our estimates are comparable to other published work. Results suggested a trend towards higher utilization among adults with MCI or ADRD compared to those who were cognitively intact. We must confirm our findings in other settings to better understand how to optimize systems of acute illness care for individuals with MCI and ADRD. The online version contains supplementary material available at 10.1186/s12877-022-03093-5.
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DOI：
10.1111/acem.14105
发表时间：
2021-03
期刊：
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
影响因子：
--
作者：
Benjenk I;DuGoff EH;Jacobsohn GC;Cayenne N;Jones CMC;Caprio TV;Cushman JT;Green RK;Kind AJH;Lohmeier M;Mi R;Shah MN
通讯作者：
Shah MN
影响因子：
3
作者：
Johnson, Pamela Jo;Ghildayal, Neha;Hokanson, Jon S.
通讯作者：
Hokanson, Jon S.
影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN
影响因子：
14
作者：
Sleeman, Katherine E.;Perera, Gayan;Higginson, Irene J.
通讯作者：
Higginson, Irene J.
影响因子：
5.7
作者：
Plassman, B. L.;Langa, K. M.;Wallace, R. B.
通讯作者：
Wallace, R. B.