Risk of infection following a visit to the emergency department: a cohort study
Risk of infection following a visit to the emergency department: a cohort study
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DOI：
10.1503/cmaj.110372
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发表时间：
2012-03-06
影响因子：
14.6
通讯作者：
Tremblay, Lucie
中科院分区：
文献类型：
--
作者：
Quach, Caroline;McArthur, Margaret;Tremblay, Lucie
背景：急诊科就诊后感染的风险尚不清楚。我们探讨了这种风险的老年居民的长期护理facility.Methods：我们比较了新的呼吸道和胃肠道感染的老年居民年龄在65岁及以上的22个长期护理facility. Methods的比率。我们使用标准化的监测定义。对于在研究期间访问急诊科的每个居民，我们随机选择了两个没有访问急诊科的居民，并按设施单位，年龄和性别进行匹配。我们计算的比率和比例的新感染，我们使用条件logistic回归调整潜在的混杂variables.Results：在总的，我们包括1269居民的长期护理设施，包括424谁访问了急诊科在研究期间。除了潜在的健康状况外，（急诊就诊：平均Charlson Comorbid指数6.1，标准差[SD] 2.5;未急诊就诊：平均Charlson Comorbid指数5.5，SD 2.7; P < 0.001）和有访客的比例（去急诊科：46.9%;没有去急诊科：39.2%; P = 0.01）。总体而言，21名（5.0%）到急诊室就诊的居民和17名（2.0%）未到急诊室就诊的居民获得了新的感染。在急诊科就诊的患者中，新发感染的发生率为8.3/1000患者-天，在未就诊的患者中为3.4/1000患者-天。急诊就诊后感染风险的调整优势比为3.9（95%置信区间1.4-10.8）。解释：老年人急诊就诊与急性感染风险增加3倍以上相关。在急诊科就诊后，应考虑为住院医生采取额外的预防措施。
Background: The risk of infection following a visit to the emergency department is unknown. We explored this risk among elderly residents of long-term care facilities.Methods: We compared the rates of new respiratory and gastrointestinal infections among elderly residents aged 65 years and older of 22 long-term care facilities. We used standardized surveillance definitions. For each resident who visited the emergency department during the study period, we randomly selected two residents who did not visit the emergency department and matched them by facility unit, age and sex. We calculated the rates and proportions of new infections, and we used conditional logistic regression to adjust for potential confounding variables.Results: In total, we included 1269 residents of long-term care facilities, including 424 who visited the emergency department during the study. The baseline characteristics of residents who did or did not visit the emergency department were similar, except for underlying health status (visited the emergency department: mean Charlson Comorbidity Index 6.1, standard deviation [SD] 2.5; did not visit the emergency department: mean Charlson Comorbidity index 5.5, SD 2.7; p < 0.001) and the proportion who had visitors (visited the emergency department: 46.9%; did not visit the emergency department: 39.2%; p = 0.01). Overall, 21 (5.0%) residents who visited the emergency department and 17 (2.0%) who did not visit the emergency department acquired new infections. The incidence of new infections was 8.3/1000 patient-days among those who visited the emergency department and 3.4/1000 patient-days among those who did not visit the emergency department. The adjusted odds ratio for the risk of infection following a visit to the emergency department was 3.9 (95% confidence interval 1.4-10.8).Interpretation: A visit to the emergency department was associated with more than a threefold increased risk of acute infection among elderly people. Additional precautions should be considered for residents following a visit to the emergency department.