紧急诊所出院后的死亡率:对453599例病例的分析
Tamara Maestre-Orozco1, José-Manuel Ramos-Rincón2, Begoña Espinosa3
1Servicio de Medicina Interna. Hospital General Dr. Balmis, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España.
概括
医院急诊室 (ED) 退院后的早期死亡并不常见,但发生在患有并发病的老年患者中. 大多数死亡是预期的,但大约四分之一与ED护理中的不良事件有关,通常是由于低估了严重程度.
科学领域:
- 紧急医疗 紧急医疗
- 公共卫生 公共卫生
- 老年医学 老年医学
背景情况:
- 医院急诊室 (ED) 处理急性疾病,但患者退院后的结果需要彻底调查.
- 了解ED出院后的死亡率模式对于改善患者安全和护理过渡至关重要.
研究的目的:
- 量化和分析医院急诊部 (ED) 退院后30天内的死亡率.
- 确定死亡原因和不良事件在出院后早期死亡率中的作用.
主要方法:
- 追溯分析14岁以上的患者从第三级护理医院退院ED超过5年.
- 收集的数据包括人口统计,查尔森并发症指数 (CCI) 和死亡原因,按预期和与ED访问的关系进行分类.
- 死亡被归类为不良事件,如果与ED诊断,管理,严重程度低估或程序并发症有关.
主要成果:
- 在453,599名出院的患者中,355人在30天内死亡 (78.48例死亡/100,000例出院).
- 大多数死亡 (79.4%) 是预期的,而20.5%是意外的.
- 与ED护理相关的不良事件占死亡人数的24.2%,严重程度的低估是一个重要的因素 (10.7%).
- 死亡患者的中位年龄为83岁,CCI为6. 导致死亡的主要原因是恶性瘤,充血性心力衰竭和动脉样硬化心血管疾病.
结论:
- 在ED出院后的早期死亡率主要影响有多种并发病的老年患者,主要是由于瘤和心血管疾病.
- 虽然直接归因于ED访问的7天和30天死亡率很低,但与ED护理相关的不良事件导致大约四分之一的出院后死亡.
- 低估ED患者严重程度是意外,不良事件相关死亡的关键因素.
关键词:
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