Predictors of emergency department observation unit outcomes
Predictors of emergency department observation unit outcomes
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DOI：
10.1197/j.aem.2005.03.534
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发表时间：
2005-09-01
影响因子：
4.4
通讯作者：
Emerman, CL
中科院分区：
文献类型：
--
作者：
Burkhardt, J;Peacock, WF;Emerman, CL
背景：急性失代偿性心力衰竭（adHF）是每年约100万住院患者的原因。在其中一些病例中，使用短期住院急诊科观察单元（EDOU）减少了90天急诊科复诊和90天再住院，如果后续需要住院，则缩短了住院时间。目的：确定急诊科到达时可用的实验室和临床参数能否预测急诊科成功出院。方法：这是一项为期19个月的adHF EDOU入院回顾性分析。详细的病史，临床过程，患者管理，实验室数据和处置目的地收集通过审查电子医疗记录。记录的实验室数据包括钠、肌酐、尿素氮（BUN）、血红蛋白、b型利钠肽和ED初始收缩压的测量。分析数据预测EDOU管理后住院需求的能力。结果：共纳入385例患者。平均（+/-标准差）年龄为69.7（+/- 13.6）岁，女性占50.1%。在急诊入院胸片上，69.0%有肺水肿的证据。肌酐和BUN水平升高与入院有统计学意义；然而，在多变量分析中，只有BUN值bb0 ~ 30mg /dL能显著预测EDOU管理失败和随后的住院。结论：这些结果表明，BUN水平bbbb30 mg/dL与adHF患者入院可能性增加相关。这为急诊医生在充血性心力衰竭患者的处置计划提供了一个实用的预后工具。
Background: Acute decompensated heart failure (adHF) is the cause of approximately 1 million annual hospital admissions. In some of these, the use of a short-stay emergency department observation unit (EDOU) decreases 90-day ED revisits and 90-day rehospitalizations and, if subsequent hospitalization is required, results in shorter stays. Objectives: To determine whether laboratory and clinical parameters, available at ED arrival, predict successful EDOU discharge. Methods: This was a 19-month retrospective analysis of adHF EDOU admissions. Details of medical history, clinical course, patient management, laboratory data, and disposition destination were gathered through review of electronic medical records. Recorded laboratory data included measurements of sodium, creatinine, blood urea nitrogen (BUN), hemoglobin, b-type natriuretic peptide, and initial ED systolic blood pressure. Data were analyzed for ability to predict the requirement of hospital admission after EDOU management. Results: There were 385 patients were enrolled. The mean (+/- standard deviation) age was 69.7 (+/- 13.6) years, and 50.1% were female. On ED admission chest radiograph, 69.0% had evidence of pulmonary edema. Elevations in creatinine and BUN levels had statistically significant associations with admission; however, on multivariable analysis, only a BUN value > 30 mg/dL significantly predicted EDOU management failure, and subsequent inpatient admission. Conclusions: These results demonstrate that a BUN level > 30 mg/dL is associated with an increased likelihood of admission in patients with adHF. This provides the emergency physician with a practical prognostic tool for disposition planning in congestive heart failure patients.