新冠病毒疫情對急診近期返診患者預後的影響-以台北市某醫學中心為例

The Impact of COVID-19 on the Outcomes of Patients with Short-Term Emergency Department Revisit

陳春廷(Chung-Ting Chen)

指導教授 ： 董鈺琪

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2022年)

https://doi.org/10.6342/NTU202200760

摘要

研究背景：急診病患的近期返診一直以來都被視為維持急診醫療服務質量、工作效率和確保患者安全的一項基準。然而，自從2019年年底新冠病毒 (COVID-19)爆發以來，疫情不但肆虐著了全球的衛生系統，更是對各地急診的服務品質產生了前所未有的衝擊。
研究目的：我們試圖調查COVID-19疫情前後急診返診的病患是否存在特性與樣態上的差異。此外，我們也想進一步檢視COVID-19 疫情的流行是否會是導致急診返診病患預後不佳的決定因素。
研究方法：本研究為一項回溯性研究，我們比較COVID-19疫情前後的72小時急診返診病患的特性與樣態。我們以2020年2月至2020年6月COVID-19疫情流行後急診72小時返診的患者作為我們的研究組，而對照組則為2019年2月至2019年6月急診72小時返診的患者。關於患者的預後，我們分析了包含返診住院、返診入住加護病房、到院前心臟驟停返診以及住院後的院內死亡率等。我們使用單變項和多變項羅吉斯迴歸模型來檢定急診72小時返診病患預後的獨立預測因子。
研究結果：本研究共收案1786例急診就醫人次，其中研究組765例，對照組1021例。結果發現：研究組的患者較為年輕（53.9±22.5 vs 56.1±28.0，p=0.002），女性比例較高（66.1% vs. 47.3%，p<0.001），返診時檢傷級別升級的比例較少（11.6% vs. 15.0%，p=0.041）。兩組在返診後住院需求、入住加護病房需求或到院前心臟驟停返診這幾項預後上沒有顯著差異，但研究組的住院死亡率上升已接近統計學上臨界值差異。在羅吉斯迴歸模型中，COVID-19疫情流行與院內死亡率存在顯著相關（調整後的優勢比為2.289，95%信賴區間1.059–4.948，p=0.035）。
結論：我們發現72小時急診返診病患於COVID-19疫情流行前後，確實存在人口統計學上的特性差異，以及有臨床就醫樣態上的不同。更重要的是， COVID-19疫情的流行是急診72小時返診病患的後續住院死亡的獨立預測因子。未來在急診的醫療服務上，應考慮將大規模的傳染病流行，視為急診72小時返診病患預後不佳的危險因素之一。

關鍵字

新型冠狀病毒 ； 急診近期返診 ； 急診醫療品質 ； 急診返診預後

並列摘要

Background: Emergency department (ED) short-term revisit has been used as a benchmark to improve the health care quality of services, work efficiency, and to ensure patient safety. However, the outbreak of COVID-19 challenges the global health system and specifically impacts the EDs.
Objective: We sought to investigate whether discrepancy existed among ED revisiting cases before-and-after COVID-19 epidemic and also determine whether COVID-19 epidemic was a predictor for poor outcomes of ED revisits.
Methods: This was a retrospective study comparing the subjects with 72-hour ED revisit before-and-after COVID-19 epidemic. Patients with 72-hour ED revisit after COVID-19 epidemic were collected from February 2020 through June 2020 as our study group, while control group from February 2019 through June 2019. The investigated outcomes included hospital admission, intensive care unit (ICU) admission, out-of-hospital cardiac arrest (OHCA) and subsequent in-hospital mortality. Univariate and multivariate logistic regression were used to identify independent predictors for outcomes of 72-hour ED revisit.
Results: A total of 1786 patients were enrolled in our study, with 765 in study group and 1021 in control group. Patients in study group were younger (53.9±22.5 vs 56.1±28.0, p=0.002), more likely to be female (66.1% vs. 47.3%, p<0.001), and less escalation of triage level when revisiting (11.6% vs 15.0%, p=0.041). There was no significant difference in outcomes of hospital admission, ICU admission or revisit with OHCA between the two groups but borderline higher in-hospital mortality in study group. In logistic regression model, COVID-19 epidemic was significantly associated with in-hospital mortality (adjusted odds ratio 2.289, 95% confidence interval [CI] 1.059–4.948, p=0.035).
Conclusions: Distinct demographic and clinical patterns of 72-hour ED revisits existed before-and-after COVID-19 epidemic and COVID-19 epidemic was an independent predictor for in-hospital mortality of 72-hour ED revisits. Large-scale contagious disease should be taken into consideration as one of the risk factors for poor outcome of 72-hour ED revisits.

並列關鍵字

COVID-19 ； emergency department revisit ； epidemic ； healthcare quality ； metrics ； quality measure

參考文獻

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