Risk Factors for Increased ED Utilization in a Multinational Cohort of Children With Sickle Cell Disease
Risk Factors for Increased ED Utilization in a Multinational Cohort of Children With Sickle Cell Disease
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DOI：
10.1111/j.1553-2712.2012.01364.x
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发表时间：
2012-06-01
影响因子：
4.4
通讯作者：
DeBaun, Michael R.
中科院分区：
文献类型：
--
作者：
Glassberg, Jeffrey A.;Wang, Jason;DeBaun, Michael R.
目的：目的是确定儿童镰状细胞病（SCD）急诊科（ED）使用率增加的临床、社会和环境风险因素。方法：本研究是对国际多中心无症状脑梗死输血（SIT）试验中ED使用数据的二次分析。在2004年12月至2010年6月期间，收集了参与试验的SCD儿童的基线人口统计学、临床和实验室数据。主要结果是因疼痛就诊的频率。次要结果是急性胸综合征的急诊科就诊频率。结果：样本包括来自美国、加拿大、英国和法国的985名儿童，总共有2955例患者年的数据。每位患者每年因疼痛就诊0.74次。既往哮喘病史与因疼痛（比率比[RR] = 1.28, 95%可信区间[CI] = 1.04至1.58）和急性胸综合征（RR = 1.60, 95% CI = 1.03至2.49）而使用ED的风险增加相关。暴露于家庭环境中的烟草烟雾与73%的急性胸综合征急诊科就诊相关（RR = 1.73, 95% CI = 1.09至2.74）。家庭收入每增加1万美元，因疼痛就诊的患者减少5% （RR = 0.95, 95% CI = 0.91至1.00,p = 0.05）。低收入与ED使用之间的关联在美国与普及医疗保健的国家没有显著差异（p = 0.51）。结论：哮喘和暴露于环境烟草烟雾是SCD儿童使用ED的潜在可改变的危险因素。在有和没有全民卫生保健的国家，低收入与更多的ED用于治疗SCD疼痛有关。学术急诊医学2012；19: 664-672 (C) 2012，由学术急诊医学学会
Objectives: The objective was to identify clinical, social, and environmental risk factors for increased emergency department (ED) use in children with sickle cell disease (SCD).Methods: This study was a secondary analysis of ED utilization data from the international multicenter Silent Cerebral Infarct Transfusion (SIT) trial. Between December 2004 and June 2010, baseline demographic, clinical, and laboratory data were collected from children with SCD participating in the trial. The primary outcome was the frequency of ED visits for pain. A secondary outcome was the frequency of ED visits for acute chest syndrome.Results: The sample included 985 children from the United States, Canada, England, and France, for a total of 2,955 patient-years of data. There were 0.74 ED visits for pain per patient-year. A past medical history of asthma was associated with an increased risk of ED utilization for both pain (rate ratio [RR] = 1.28, 95% confidence interval [CI] = 1.04 to 1.58) and acute chest syndrome (RR = 1.60, 95% CI = 1.03 to 2.49). Exposure to environmental tobacco smoke in the home was associated with 73% more ED visits for acute chest syndrome (RR = 1.73, 95% CI = 1.09 to 2.74). Each $10,000 increase in household income was associated with 5% fewer ED visits for pain (RR = 0.95, 95% CI = 0.91 to 1.00, p = 0.05). The association between low income and ED utilization was not significantly different in the United States versus countries with universal health care (p = 0.51).Conclusions: Asthma and exposure to environmental tobacco smoke are potentially modifiable risk factors for greater ED use in children with SCD. Low income is associated with greater ED use for SCD pain in countries with and without universal health care. ACADEMIC EMERGENCY MEDICINE 2012; 19: 664-672 (C) 2012 by the Society for Academic Emergency Medicine