不是所有的胆囊炎都是平等的:不平等导致ED呈现和门诊算法的失败
W Taylor Martin1, Jonathan Ball1, A Kathryn Patterson1
1University of Oklahoma General Surgery Department, USA.
American journal of surgery
|July 22, 2023
概括
通过急诊室 (ED) 进行胆囊切除术的未保险患者有更高的治疗失败风险. 这凸显了对胆结石病的护理差异,特别是在脆弱人群中.
科学领域:
- 胃肠病学 胃肠病学
- 手术病理学手术病理学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 慢性胆囊炎是紧急诊所 (ED) 和门诊 (OC) 患者的主要最终手术病理.
- 在ED利用和OC衰竭的差异需要区分这些患者群体.
研究的目的:
- 为了区分ED和OC患者之间慢性胆囊炎的表现.
- 识别与ED利用和OC失败相关的护理差异.
主要方法:
- 对单一机构的胆固醇胆病胆固醇切除术的回顾性图表审查.
- 临床表现的评估,最终的外科病理,人口统计和邮政编码贫困 (ZCP).
- 使用总结统计,双变量比较和后勤回归进行数据分析.
主要成果:
- 门诊 (OC) 患者比急诊 (ED) 患者更有可能是白人和受保险者.
- 保险费率随着邮政编码贫困 (ZCP) 水平的增加而大幅下降.
- 没有保险的ED患者对不良结果的几率比率 (OR) 显著更高.
结论:
- 没有保险的ED患者容易失败门诊算法,特别是在超声波误诊的情况下.
- 在这个人群中,胆囊炎的临床诊断要求提供紧急胆囊切除术.
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