ACS患者医院资源利用的变化:是否是时候在ED中进行先进的NSTEMI风险分层?
Monica Saxena1, Sean M Bloos2, Anna Graber-Naidich3
1Department of Emergency Medicine, Stanford University School of Medicine, 900 Welch Road, Ste 350, Palo Alto, CA 94304, United States of America.
The American journal of emergency medicine
|June 16, 2023
概括
非ST升高心肌梗塞 (NSTEMI) 是最常见的急性冠状动脉综合征 (ACS). 在急诊室的早期风险分层可以优化NSTEMI患者的护理和资源使用.
科学领域:
- 心脏病学 心脏病学
- 紧急医疗 紧急医疗
- 医疗保健服务研究 医疗服务研究
背景情况:
- 急性冠状动脉综合征 (ACS) 是一个常见的急诊室呈现.
- ST段升高心肌梗塞 (STEMI) 护理是明确的,但NSTEMI和不稳定性胸痛 (UA) 需要进一步检查.
- NSTEMI构成了大多数ACS病例,为改善急救部门 (ED) 管理提供了机会.
研究的目的:
- 为了比较NSTEMI,STEMI和UA患者之间的医院资源利用率.
- 评估在NSTEMI患者中基于ED的风险分层的潜力.
主要方法:
- 从284,945名ED患者组成的更大队列中,对1195名成年ACS患者进行了回顾性分析.
- 在ACS亚型中比较住院时间 (LOS),重症监护室 (ICU) 护理和住院死亡率.
主要成果:
- NSTEMI患者 (70%的ACS病例) 的平均住院LOS为3.7天,住院死亡率为1.6%.
- 与NSTEMI和UA相比,STEMI患者的ICU利用率 (79.1%) 和死亡率 (4.4%) 较高.
- UA患者的LOS较短 (2.99天),并且没有住院死亡率.
结论:
- 在ACS病例中,NSTEMI患者占绝大多数.
- 基于ED的NSTEMI风险分层可以指导入院决策和ICU护理,优化资源配置.
- 在ED中实施风险分层工具可以提高对大多数ACS患者的护理.
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