Clinical and Economic Burden of Emergency Department Visits Due to Gastrointestinal Diseases in the United States
Clinical and Economic Burden of Emergency Department Visits Due to Gastrointestinal Diseases in the United States
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DOI：
10.1038/ajg.2013.199
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发表时间：
2013-09-01
影响因子：
9.8
通讯作者：
Ladabaum, Uri
中科院分区：
文献类型：
--
作者：
Myer, Parvathi A.;Mannalithara, Ajitha;Ladabaum, Uri
目的：胃肠道（GI）急症可能导致大量的发病率。我们的目的是表征美国急诊科（EDs） GI访问的国家临床和经济负担。方法：我们使用2007年全国急诊科样本（美国最大的全付费急诊科数据库）进行了一项观察性横断面研究，以确定因胃肠道疾病就诊的主要原因及其相关费用，并按年龄和性别分层。采用Logistic回归分析急诊科就诊后住院的预测因素。结果：在2007年的1.22亿急诊科就诊中，1500万（12%）有原发性胃肠道诊断。主要的胃肠道诊断是腹痛（470万次就诊）、恶心和呕吐（160万次就诊）和消化系统功能紊乱（70万次就诊）。主要的诊断因年龄组而异。在原发性胃肠道诊断中，急诊科就诊导致住院的比例为21.6%，而非胃肠道就诊的比例为14.7%。与男性相比，女性因原发性胃肠道诊断就诊的ED次数更多（每1000人58.5次（95% CI 56.0-60.9） vs. 41.6次（95% CI 39.8-43.3）），但后续住院率较低(20.0% （95% CI 19.4-20.7%) vs. 24.0% (95% CI 23.3-24.6%)）。经年龄、原发性GI诊断和Charlson合并症评分调整后，住院率在性别间无差异。2007年，因初级胃肠病诊断而到急诊科就诊的总收费为279亿元。结论：胃肠道疾病是美国紧急医疗服务的重大临床和经济负担。
OBJECTIVES: Gastrointestinal (GI) emergencies may cause substantial morbidity. Our aims were to characterize the national clinical and economic burden of GI visits to emergency departments (EDs) in the United States.METHODS: We performed an observational cross-sectional study using the 2007 Nationwide Emergency Department Sample, the largest US all-payer ED database, to identify the leading causes for ED visits due to GI diseases and their associated charges, stratified by age and sex. Logistic regression was used to analyze predictors of hospitalization after an ED visit.RESULTS: Of the 122 million ED visits in 2007, 15 million (12%) had a primary GI diagnosis. The leading primary GI diagnoses were abdominal pain (4.7 million visits), nausea and vomiting (1.6 million visits), and functional disorders of the digestive system (0.7 million visits). The leading diagnoses differed by age group. The fraction of ED visits resulting in hospitalization was 21.6% for primary GI diagnoses vs. 14.7% for non-GI visits. Women had more ED visits with a primary GI diagnosis than men (58.5 (95% CI 56.0-60.9) vs. 41.6 (95% CI 39.8-43.3) per 1000 persons), but lower rates of subsequent hospitalization (20.0% (95% CI 19.4-20.7%) vs. 24.0% (95% CI 23.3-24.6%)). There were no differences in hospitalization rates between sexes after adjustment by age, primary GI diagnosis, and Charlson Comorbidity Score. The total charges for ED visits with a primary GI diagnosis in 2007 were $27.9 billion.CONCLUSIONS: GI illnesses account for substantial clinical and economic burdens on US emergency medical services.