对于患有低风险昏迷的患者,向急诊室呈现的住院患者的医院间变异性
Anthony J Mazzella1, Brian S Wood2, Jagroop Doad3
1Division of Cardiology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Heart rhythm O2
|August 9, 2024
概括
医院选择对低风险患者的入院率产生重大影响. 医院的不测量因素,而不仅仅是患者的特点,驱动着急诊室 (ED) 的这些入院变化.
科学领域:
- 紧急医疗 紧急医疗
- 临床决策 临床决策
- 改善医疗保健质量 改善医疗保健质量
背景情况:
- 标准化的指导方针和风险评分旨在在急诊室 (ED) 管理昏.
- 尽管有现有的工具,但临床实践中对于昏迷管理的显著差异仍然存在.
研究的目的:
- 调查影响低风险昏迷患者进入医院入院的因素.
- 确定与入院决策相关的患者特定和医院相关的变量.
主要方法:
- 从全国急诊部样本 (2006-2019) 中分析了成年人昏迷的情况.
- 多变量层次逻辑回归来确定与入学相关的因素.
- 参考效应测量方法用于量化患者,医院和未测量的医院因素的贡献.
主要成果:
- 在804,398名低风险昏迷患者中,有2.5%被录取.
- 年龄的增加和周末的表现增加了入学几率.
- 女性性别,缺乏保险,医院地区,教学地位和ED数量与较低的入院率有关.
- 未测量的部位变异性显示了入院几率的最大范围 (OR 0.23-4.38).
结论:
- 低风险昏迷的入院率在医疗机构之间存在很大差异.
- 未测量的机构因素在昏迷入院的变化中起着重要作用.
- 需要进一步的基于证据的指导,以标准化ED中的昏迷护理,并减少实践的变化.
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