与儿科创伤患者违背医疗建议离开相关的因素
Ali Makhdoom1, Abimbola Pratt2, Yen-Hong Kuo3
1Hackensack Meridian School of Medicine, Nutley, NJ, USA.
The American journal of emergency medicine
|March 3, 2024
概括
违背医疗建议 (AMA) 的出院在黑人儿科创伤患者,自费保险者和年长儿童中更为常见. 解决这些差异对于改善儿科创伤护理至关重要.
科学领域:
- 创伤外科手术是什么
- 儿科急诊医学 儿科急诊医学
- 医疗服务研究 医疗服务研究
背景情况:
- 违背医疗建议 (AMA) 的出院与患者不良结果和医疗保健成本增加有关.
- 有限的研究存在于特别在儿科创伤人群内AMA释放.
- 了解儿科创伤中AMA出院的风险因素对于有针对性的干预措施至关重要.
研究的目的:
- 识别和分析与儿童创伤患者违背医疗建议离开相关的风险因素.
- 探索人口统计学,临床和受伤相关特征,预测儿童的AMA排出.
主要方法:
- 从国家创伤数据库 (2017-2019) 来对儿科创伤患者 (年龄<18) 的回顾性分析.
- 纳入标准:儿科创伤患者;分析的数据点:年龄,种族,性别,格拉斯哥昏迷表,创伤类型,保险,缩略伤害表.
- 统计分析:多重物流回归模型,以确定与AMA排放的关联.
主要成果:
- 与非黑人患者相比,黑人儿科创伤患者的AMA排出可能性更高 (OR 1.987).
- 患有自付保险 (OR 1.759) 和重创伤 (OR 1.683) 的患者更容易发生AMA出院.
- 增加年龄与更高的AMA出院率相关 (或每年1.150),而严重的腹部或下肢损伤降低了这种可能性.
结论:
- 种族,保险状况,受伤类型和患者年龄是儿科创伤中AMA出院的重要预测因素.
- 黑人儿科创伤患者的AMA出院率不成比例地高,这表明种族差异.
- 未来的干预措施应侧重于解决种族和社会经济因素,以减少儿科创伤护理中AMA出院率.
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