米兰体育官网 急诊科就诊后的多发病和不良后果：基于人群的队列研究

引用

Blayney MC、Reed MJ、Masterson JA、Anand A、Boamrane MM、Fleuriot J、Luz S、Lyall MJ、Mercer S、Mills NL、Shenkin SD、Walsh TS、Wild SH、Wu H 和 McLachlan S (2024) 急诊科就诊后的多重发病率和不良后果：基于人群的队列 学习。BMJ 医学，3，艺术。编号：e000731。 https://doi.org/10.1136/bmjmed-2023-000731

摘要
目标：描述多发病对急诊科患者以患者为中心的不良结局的影响。 设计：基于人群的队列研究。 地点：2012年1月1日至2019年12月31日期间，苏格兰NHS洛锡安急诊室。 参与者：急诊科就诊的成年人（≥18 岁）。 数据来源：来自急诊科、医院出院和癌症登记处的关联数据以及国家死亡率数据。 主要结果指标：多重发病被定义为 Elixhauser 合并症指数中的至少两个条件。使用多变量逻辑回归或线性回归来评估多发病与 30 天死亡率（主要结果）、入院、7 天内再次到急诊科就诊以及在急诊科花费的时间（次要结果）的关联。主要分析按年龄分层 (65 v ≥65 years). Results: 451 291 people had 1 273 937 attendances to emergency departments during the study period. 43 504 (9.6%) had multimorbidity, and people with multimorbidity were older (median 73 v 43 years), more likely to arrive by emergency ambulance (57.8% v 23.7%), and more likely to be triaged as very urgent (23.5% v 9.2%) than people who do not have multimorbidity. After adjusting for other prognostic covariates, multimorbidity, compared with no multimorbidity, was associated with higher 30 day mortality (8.2% v 1.2%, adjusted odds ratio 1.81 (95% confidence interval (CI) 1.72 to 1.91)), higher rate of hospital admission (60.1% v 20.5%, 1.81 (1.76 to 1.86)), higher reattendance to an emergency department within seven days (7.8% v 3.5%, 1.41 (1.32 to 1.50)), and longer time spent in the department (adjusted coefficient 0.27 h (95% CI 0.26 to 0.27)). The size of associations between multimorbidity and all outcomes were larger in younger patients: for example, the adjusted odds ratio of 30 day mortality was 3.03 (95% CI 2.68 to 3.42) in people younger than 65 years versus 1.61 (95% CI 1.53 to 1.71) in those 65 years or older. Conclusions: Almost one in ten patients presenting to emergency department had multimorbidity using Elixhauser index conditions. Multimorbidity was strongly associated with adverse outcomes and these associations were stronger in younger people. The increasing prevalence of multimorbidity in the population is likely to exacerbate strain on emergency departments unless practice and policy evolve to meet the growing demand.

关键字
多种疾病；不良后果；不良事件；术后并发症； 紧急护理；多变量逻辑回归

注释
其他作者： 布鲁斯·格思里；纳齐尔我孤独

期刊
BMJ 医学：第 3 卷

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