基于急性护理电话转诊的急性内科医生的临床直觉:一项前性研究
Paul M E L van Dam1, Roberto E Lasso Peña1, Jody A Mommertz1
1Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Center +, Maastricht, The Netherlands.
急性内科医生急性内科医生
科学领域:
- 紧急医疗 紧急医疗
- 临床决策 - 临床决策
- 医疗保健管理的管理
背景情况:
- 在荷兰,大多数急诊室 (ED) 患者由全科医生或医院专家转诊.
- 在电话转诊期间早期风险分层可能会改善患者病情严重程度的医院前评估.
- 这项研究评估了急性内科 (AIM) 医生基于电话推的临床直觉的预测准确性.
研究的目的:
- 评估AIM医生临床直觉在预测ED患者短期不良结果方面的歧视价值.
- 确定AIM医生用于这些预测的关键信息.
- 评估医院前风险分层和改善ED患者流量管理的潜力.
主要方法:
- 对成人ED患者进行前性研究,转诊为内科.
- 主要结局:住院和曼彻斯特分辨系统 (MTS) 类别.
- 二次结果:31天死亡率. 通过使用接收器运行特征曲线 (AUC) 下的面积和使用相关系数的协议来评估歧视性性能.
主要成果:
- AIM医生的临床直觉表明,医院入院 (AUC 0.72) 和31天死亡率 (AUC 0.73) 的区分性表现良好.
- 重要预测因素包括65岁以上的年龄和"警报感".
- 在预测和观察到的MTS分类类别 (ICC 0.48,Spearman's 0.29) 之间观察到公平协议.
结论:
- 在电话推期间的临床直觉对于预测患者短期结果是有效的.
- 这种能力使得在医院前环境中能够进行早期风险分层.
- 有效的医院前风险评估可以带来更有效的急诊室患者流量管理.
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