National trends in resource utilization associated with ED visits for syncope.
National trends in resource utilization associated with ED visits for syncope.
复制标题
与ED访问有关的晕厥访问相关的资源利用率的国家趋势。
DOI：
10.1016/j.ajem.2015.04.030
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发表时间：
2015-08
期刊：
影响因子：
--
通讯作者：
Sun BC
中科院分区：
文献类型：
--
作者：
Probst MA;Kanzaria HK;Gbedemah M;Richardson LD;Sun BC
在过去的20年里，已经发表了大量旨在优化急诊科(ED)晕厥患者资源利用的研究文章和临床指南。我们假设晕厥相关急诊的时间趋势，以及影像、住院和诊断频率的相关趋势。对2001至2010年间全国医院非卧床医疗护理调查中的急诊部分进行了分析，共有358,000多人次就诊(全国估计有11.8亿人次就诊)。我们选择了有晕厥或晕厥原因的急诊室就诊，并计算了具有全国代表性的此类就诊患病率的加权估计，以及先进影像利用和入院的相关比率。对于2005至2010年的住院患者，最频繁的出院诊断被列在了表格中。在研究期间，与晕厥有关的实际急症室就诊人次超过3,500人次(相当于全国1,190万人次)，约占所有急症室就诊人次的1%。晕厥患者入院率为27%~35%，无明显下降趋势(p=0.1)。高级成像率从约21%上升到45%，并呈显著上升趋势(p<；0.001)。在住院患者中，最常见的出院诊断是“晕厥和晕倒”的症状诊断(36.4%)。尽管医学研究人员和专业协会做出了很大努力，但与晕厥急诊相关的资源利用似乎实际上有所增加。在入院诊断效率方面没有明显的改善。可能需要新的策略来改变这类患者的实践模式。
Over the last 20 years, numerous research articles and clinical guidelines aimed at optimizing resource utilization for emergency department (ED) patients presenting with syncope have been published. We hypothesized there would be temporal trends in syncope-related ED visits and associated trends in imaging, hospital admissions, and diagnostic frequencies. The ED component of National Hospital Ambulatory Medical Care Survey was analyzed from 2001 through 2010, comprising over 358,000 visits (representing an estimated 1.18 billion visits nationally). We selected ED visits with a reason for visit of syncope or fainting and calculated nationally representative weighted estimates for prevalence of such visits, and associated rates of advanced imaging utilization and admission. For admitted patients from 2005 to 2010, the most frequent hospital discharge diagnoses were tabulated. During the study period, there were over 3,500 actual ED visits (representing 11.9 million visits nationally) related to syncope, representing roughly 1% of all ED visits. Admission rates for syncope patients ranged from 27% to 35% and showed no significant downward trend (p=0.1). Advanced imaging rates increased from about 21% to 45% and showed a significant upward trend (p < 0.001). For admitted patients, the most common hospital discharge diagnosis was the symptomatic diagnosis of “syncope and collapse” (36.4%). Despite substantial efforts by medical researchers and professional societies, resource utilization associated with ED visits for syncope appears to have actually increased. There have been no apparent improvements in diagnostic yield for admissions. Novel strategies may be needed to change practice patterns for such patients.
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