病例数量和重症急诊患者的专业化:日本ICU的全国性队列研究
Jun Fujinaga1, Takanao Otake2, Takehide Umeda2,3
1Emergency and Critical Care Center, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki City, Okayama, 710-8602, Japan. junf15june84@gmail.com.
较高的重症监护室 (ICU) 病例数量与日本重症急诊患者的死亡率降低有关. 在ICU中的专业化和集中护理可能会改善患者的治疗结果.
科学领域:
- 临界护理医学 临界护理医学
- 医疗保健服务研究 医疗服务研究
- 流行病学 流行病学
背景情况:
- 之前的研究表明,病例数量与危急疾病和手术中的患者结果之间存在联系.
- 重症监护室 (ICU) 病例数量和专业化对重症急诊患者的影响仍然是需要进一步调查的领域.
研究的目的:
- 检查ICU病例数量,专业化和患者结果之间的关联.
- 确定ICU病例数量和专业化如何影响日本ICU重症急诊患者的治疗结果.
主要方法:
- 使用日本重症监护患者数据库 (JIPAD) (2015年4月至2021年3月) 的数据进行回顾性队列研究.
- 包括80个日本ICU的72,214名年龄≥16岁的急诊患者.
- 主要结局:住院死亡率. 二次结果:ICU死亡率,28天死亡率,无呼吸器日,ICU和住院时间长度.
- 贝叶斯基层次的通用线性混合模型被用于分析.
主要成果:
- 较高的ICU病例数量与医院死亡率的降低有显著的关联.
- >75%急诊患者的ICU显示,随着病例数量的增加,死亡率下降更明显.
- 与最低四分位数 (Q1) 相比,在较高病例量四分位数 (Q2,Q3,Q4) 中,住院死亡率的几率比率下降.
- 对于二次结果措施也观察到类似的趋势.
结论:
- 增加的ICU病例数量与日本ICU治疗主要是急诊患者的医院内死亡率较低有显著的联系.
- 调查结果强调了ICU专业化的重要性以及集中护理对重症急诊患者的潜在好处.
- 结果为日本的医疗保健政策提供了见解,并可能与全球类似的医疗保健系统相关.
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