急诊室的体积和儿科尾炎的延迟诊断:一个回顾性队列研究
Kenneth A Michelson1, Richard G Bachur1, Shawn J Rangel2
1Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.
Annals of surgery
|June 30, 2023
概括
儿童的急诊室 (ED) 容量较高与较少的延迟尾炎诊断有关. 儿童尾炎的延迟诊断增加了严重并发症的风险.
科学领域:
- 儿科急救医学 儿科急救医学
- 外科手术的结果
- 医疗保健服务研究 医疗服务研究
背景情况:
- 儿童尾炎的延迟诊断是一个重大的临床挑战.
- 急诊室 (ED) 患者数量对儿科尾炎诊断及时性的影响尚不清楚.
- 对特定疾病的经验增加可能会提高诊断的准确性和速度.
研究的目的:
- 调查急诊室 (ED) 患者数量与儿科尾炎延迟诊断的可能性之间的关联.
- 为了确定更高的ED或尾炎患者体积是否与诊断延迟减少相关.
- 评估与儿童延迟尾炎诊断相关的下游并发症.
主要方法:
- 从8个州 (2014-2019) 获取的医疗保健成本和利用计划 (HCUP) 数据.
- 在所有ED中分析了18岁以下患者尾炎的病例.
- 采用分层模型来评估ED体积和可能的延迟诊断之间的关系,调整共变量;使用验证的测量方法定义可能的延迟 (>75%的概率).
主要成果:
- 总共有93,136例儿科尾炎病例被分析,其中3.5%的人经历了延迟诊断.
- 总体ED体积的每一次翻一番与延迟诊断的几率下降6.9%相关.
- 尾炎特异性体积的每一次翻一番都显示出延迟的几率下降了24.1%,更为实质性.
- 延迟诊断显著增加了重症监护室入院,穿孔尾炎,腹部,多次手术和败血症的可能性.
结论:
- 增加急诊室 (ED) 患者数量与儿童延迟尾炎诊断的风险降低有关.
- 儿童尾炎的延迟诊断与严重并发症的更高发病率密切相关.
- 优化ED资源配置,并可能集中治疗尾炎,可以改善诊断及时性和患者的治疗结果.
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