急診三日內再回診病患收住加護病房之探討

An Analysis of Intensive Care Unit Admission for Patients Revisiting Emergency Department within 3 Days

范渚鑫(Ju-Sing Fan) ； 高偉峰(Wei-Fong Kao) ； 顏鴻章(David Hung-Tsang Yen) ； 王立敏(Lee-Min Wang) ； 黃俊一(Chun-I Huang) ； 李建賢(Chen-Hsen Lee)

《Journal of Emergency Medicine, Taiwan》 7卷1期 (2005/03) Pp. 8-19

摘要

Background: The clinical features of patients who revisited emergency department (ED) within 3 days and were admitted to intensive care unit (ICU) have not been elucidated.
Methods: From Jan. 1, 2002 to Nov. 30, 2003, all acute critical illness patients who revisited our ED within 3 days and were admitted to ICU were enrolled in this study. Using the demographic data and clinical features of all studied patients, we analyzed and categorized patients into 3 groups, those responding poorly to treatment (treatment failure), those with missed diagnosis, and those developing new clinical events resulting in physical deterioration. Based on the factors that contribute to the patient's revisiting, we divided all studied patients into 2 groups, those revisited due to physician-related factors and those revisited due to non-physician-related factors. We compared the demographic data, clinical features, severity of disease, and prognosis of patients in respective groups.
Result: A total of 116 patients revisited ED within 3 days and were admitted to ICU. The mean age was 71.3±15.4 (SD) years. There were 47 patients (40.5%) responded poorly to treatment and 41 patients (35.5%) had a missed diagnosis. Pneumonia is the most common diagnosis in 21 patients (18.1%). When comparing the treatment failure group to the missed diagnoses group, the treatment failure group has shorter duration between two visits (31.5±18.5 vs. 40.0±21.5, p＜0.05), higher acute physiology and chronic health evaluation score (24.0±5.2 vs. 15.2±6.6, p＜0.05). A total of 56 patients (48.3%) were attributed to physician-related, whereas 60 patients (51.7%) were attributed to non-physician related group. One mortality was physician-related and 16 mortalities were non-physician-related (26.7% vs. 1.8%, p＜0.0l).
Conclusions: Our study demonstrated that most ICU admissions and mortalities for revisiting patients were associated with elderly, who have multiple chronic co-morbidities. Patients who responded poorly to treatment in previous visits have poorer prognosis than those with missed diagnoses. Patients belonging to non-physician-related group have higher mortalities than those belonging to physician-related group. Our results implicated that more attentions should be pay to accurate diagnosis and longer treatment programs for the patients who were either elderly or have multiple chronic co-morbidies, to reduce the ICU admission and mortality rate for revisiting patients.

關鍵字

急診部門 ； 再回診 ； 加護病房

並列摘要

Background: The clinical features of patients who revisited emergency department (ED) within 3 days and were admitted to intensive care unit (ICU) have not been elucidated.
Methods: From Jan. 1, 2002 to Nov. 30, 2003, all acute critical illness patients who revisited our ED within 3 days and were admitted to ICU were enrolled in this study. Using the demographic data and clinical features of all studied patients, we analyzed and categorized patients into 3 groups, those responding poorly to treatment (treatment failure), those with missed diagnosis, and those developing new clinical events resulting in physical deterioration. Based on the factors that contribute to the patient's revisiting, we divided all studied patients into 2 groups, those revisited due to physician-related factors and those revisited due to non-physician-related factors. We compared the demographic data, clinical features, severity of disease, and prognosis of patients in respective groups.
Result: A total of 116 patients revisited ED within 3 days and were admitted to ICU. The mean age was 71.3±15.4 (SD) years. There were 47 patients (40.5%) responded poorly to treatment and 41 patients (35.5%) had a missed diagnosis. Pneumonia is the most common diagnosis in 21 patients (18.1%). When comparing the treatment failure group to the missed diagnoses group, the treatment failure group has shorter duration between two visits (31.5±18.5 vs. 40.0±21.5, p＜0.05), higher acute physiology and chronic health evaluation score (24.0±5.2 vs. 15.2±6.6, p＜0.05). A total of 56 patients (48.3%) were attributed to physician-related, whereas 60 patients (51.7%) were attributed to non-physician related group. One mortality was physician-related and 16 mortalities were non-physician-related (26.7% vs. 1.8%, p＜0.0l).
Conclusions: Our study demonstrated that most ICU admissions and mortalities for revisiting patients were associated with elderly, who have multiple chronic co-morbidities. Patients who responded poorly to treatment in previous visits have poorer prognosis than those with missed diagnoses. Patients belonging to non-physician-related group have higher mortalities than those belonging to physician-related group. Our results implicated that more attentions should be pay to accurate diagnosis and longer treatment programs for the patients who were either elderly or have multiple chronic co-morbidies, to reduce the ICU admission and mortality rate for revisiting patients.

並列關鍵字

emergency department ； revisit ； critical care unit