Increasing critical care admissions from U.S. emergency departments, 2001-2009.
Increasing critical care admissions from U.S. emergency departments, 2001-2009.
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DOI：
10.1097/ccm.0b013e31827c086f
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发表时间：
2013-05
影响因子：
8.8
通讯作者：
Camargo CA Jr
中科院分区：
文献类型：
--
作者：
Herring AA;Ginde AA;Fahimi J;Alter HJ;Maselli JH;Espinola JA;Sullivan AF;Camargo CA Jr
关于最近全系统对重症监护需求的增加如何影响美国急诊科（ED），人们知之甚少。这项研究描述了2001年至2009年期间美国急诊科提供的重症监护量的变化。2001-2009年全国医院门诊医疗护理调查数据分析。美国艾德数据的国家多级概率样本。美国艾德的能力是使用美国国家紧急情况部门目录估计的。艾德患者入住重症监护室。没有。基于急诊的重症监护的年小时数和重症监护艾德年就诊次数。重症艾德患者的临床特征、人口统计学、保险状态、环境、地理区域和艾德住院时间。美国急诊科每年收治的重症监护室人数从120万增加到220万，增加了79%。所有艾德就诊导致重症监护室入院的比例从0.9%增加到1.6%（p趋势< 0.001）。2001年至2009年，重症患者的中位艾德住院时间从185分钟增加到245分钟（+ 60分钟; p趋势< 0.02）。在2001-2009年的汇总中，黑人患者（长12.6%）和西班牙裔患者（长14.8%）的重症监护访视的艾德住院时间长于白色患者，所有重症监护艾德访视中有三分之一的艾德住院时间超过6小时。2001年至2009年间，美国急诊科的重症监护年总小时数从320万增加到1010万，增长了217%（p趋势< 0.001）。美国急诊室提供的重症监护的平均每日量增加了两倍，从每个艾德每天1.8小时增加到5.6小时。在过去的十年中，美国急诊科提供的重症监护数量大幅增加，这是由于重症监护艾德就诊次数增加和艾德住院时间延长。重症监护负担的增加将进一步加剧已经产能过剩的美国紧急护理系统的压力。
Little is known about how recent system-wide increases in demand for critical care have affected U.S. emergency departments (EDs). This study describes changes in the amount of critical care provided in U.S. EDs between 2001 and 2009. Analysis of data from the National Hospital Ambulatory Medical Care Survey for the years 2001–2009. National multistage probability sample of U.S. ED data. U.S. ED capacity was estimated using the National Emergency Department Inventory-United States. ED patients admitted a critical care unit. None. Annual hours of ED-based critical care and annual number critical care ED visits. Clinical characteristics, demographics, insurance status, setting, geographic region, and ED length of stay for critically ill ED patients. Annual critical care unit admissions from U.S. EDs increased by 79% from 1.2 to 2.2 million. The proportion of all ED visits resulting in critical care unit admission increased from 0.9% to 1.6% (ptrend < 0.001). Between 2001 and 2009, the median ED length of stay for critically ill patients increased from 185 to 245 minutes (+ 60 min; ptrend < 0.02). For the aggregated years 2001–2009, ED length of stay for critical care visits was longer among black patients (12.6% longer) and Hispanic patients (14.8% longer) than among white patients, and one third of all critical care ED visits had an ED length of stay greater than 6 hrs. Between 2001 and 2009, total annual hours of critical care at U.S. EDs increased by 217% from 3.2 to 10.1 million (ptrend < 0.001). The average daily amount of critical care provided in U.S. EDs tripled from 1.8 to 5.6 hours per ED per day. The amount of critical care provided in U.S. EDs has increased substantially over the past decade, driven by increasing numbers of critical care ED visits and lengthening ED length of stay. Increased critical care burden will further stress an already overcapacity U.S. emergency care system.