Emergency department visits by older adults for motor vehicle collisions.
Emergency department visits by older adults for motor vehicle collisions.
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DOI：
10.5811/westjem.2013.2.12230
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发表时间：
2013-11
期刊：
影响因子：
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通讯作者：
Betz ME
中科院分区：
文献类型：
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作者：
Vogel JA;Ginde AA;Lowenstein SR;Betz ME
描述美国老年人机动车碰撞（MVC）急诊（ED）就诊的流行病学和特征。我们使用2003-2007年全国医院门诊医疗调查（NHAMCS）的数据分析了mvc的急诊就诊情况。使用美国人口普查数据，我们计算了驾驶员或乘客与心血管疾病相关的急诊科就诊的年发病率，并检查了就诊特征，包括分诊灵敏度、进行的检查和住院或出院。我们比较老年（65岁以上）和年轻（18-64岁）MVC患者，并计算比值比（OR）和95%置信区间（ci）来衡量年龄组和各种就诊特征之间的关联强度。使用多变量逻辑回归来确定老年人中mvc相关损伤入院的独立预测因素。从2003年到2007年，每年平均有23.7万老年人因mvc去急诊室就诊。mvc的年ED就诊率为老年人每1000人6.4次（95% CI 4.6-8.3），年轻人每1000人16.4次（95% CI 14.0-18.8）。与年轻的MVC患者相比，在调整性别、种族和民族后，老年MVC患者更有可能至少进行一次影像学研究（OR 3.69, 95% CI 1.46-9.36）。调整性别、种族和民族因素后，与年轻的MVC患者相比，老年MVC患者乘坐救护车到达的可能性（OR 1.47; 95% CI 0.76-2.86）、分诊灵敏度高（OR 1.56; 95% CI 0.77-3.14）或被诊断为头部、脊髓或躯干损伤的可能性（OR 0.97; 95% CI 0.42-2.23）并不显著增加。总体而言，14.5% （95% CI 9.8-19.2）的老年MVC患者和6.1% （95% CI 4.8-7.5）的年轻MVC患者住院。在调整性别、种族、民族和损伤程度后，老年MVC患者与年轻MVC患者住院的趋势（OR为1.78,95% CI为0.71-4.43）和住院ICU的趋势（OR为6.9,95% CI为0.9-51.9）也无统计学意义。研究的损伤敏锐度指标包括EMS到达、高分诊敏锐度分类、ED成像以及头部、脊髓或内伤的诊断。尽管老年人在MVC后去急诊室就诊的人均比例较低，但老年人更常被送往医院和ICU。与年轻的MVC患者相比，老年MVC患者在诊断成像方面需要大量ED资源。随着美国人口老龄化，老年人继续开车，急诊科将不得不分配适当的资源，并制定诊断和治疗方案，以照顾越来越多的老年MVC受害者。
To describe the epidemiology and characteristics of emergency department (ED) visits by older adults for motor vehicle collisions (MVC) in the United States (U.S.). We analyzed ED visits for MVCs using data from the 2003–2007 National Hospital Ambulatory Medical Care Survey (NHAMCS). Using U.S. Census data, we calculated annual incidence rates of driver or passenger MVC-related ED visits and examined visit characteristics, including triage acuity, tests performed and hospital admission or discharge. We compared older (65+ years) and younger (18–64 years) MVC patients and calculated odds ratios (OR) and 95% confidence intervals (CIs) to measure the strength of associations between age group and various visit characteristics. Multivariable logistic regression was used to identify independent predictors of admissions for MVC-related injuries among older adults. From 2003–2007, there were an average of 237,000 annual ED visits by older adults for MVCs. The annual ED visit rate for MVCs was 6.4 (95% CI 4.6–8.3) visits per 1,000 for older adults and 16.4 (95% CI 14.0–18.8) visits per 1,000 for younger adults. Compared to younger MVC patients, after adjustment for gender, race and ethnicity, older MVC patients were more likely to have at least one imaging study performed (OR 3.69, 95% CI 1.46–9.36). Older MVC patients were not significantly more likely to arrive by ambulance (OR 1.47; 95% CI 0.76–2.86), have a high triage acuity (OR 1.56; 95% CI 0.77–3.14), or to have a diagnosis of a head, spinal cord or torso injury (OR 0.97; 95% CI 0.42–2.23) as compared to younger MVC patients after adjustment for gender, race and ethnicity. Overall, 14.5% (95% CI 9.8–19.2) of older MVC patients and 6.1% (95% CI 4.8–7.5) of younger MVC patients were admitted to the hospital. There was also a non-statistically significant trend toward hospital admission for older versus younger MVC patients (OR 1.78; 95% CI 0.71–4.43), and admission to the ICU if hospitalized (OR 6.9, 95% CI 0.9–51.9), after adjustment for gender, race, ethnicity, and injury acuity. Markers of injury acuity studied included EMS arrival, high triage acuity category, ED imaging, and diagnosis of a head, spinal cord or internal injury. Although ED visits after MVC for older adults are less common per capita, older adults are more commonly admitted to the hospital and ICU. Older MVC victims require significant ED resources in terms of diagnostic imaging as compared to younger MVC patients. As the U.S. population ages, and as older adults continue to drive, EDs will have to allocate appropriate resources and develop diagnostic and treatment protocols to care for the increased volume of older adult MVC victims.