预测短期复诊的患者在急诊科就诊时的高风险复诊:HANDLE-24评分

IF 2.3 3区 医学 Q1 EMERGENCY MEDICINE
Chung-Ting Chen, Po-Hsiang Liao, Meng-Chen Lin, Hsien-Hao Huang, Chorng-Kuang How, Yu-Chi Tung
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引用次数: 0

摘要

背景:急诊7h重访率是一项重要的质量指标。有些人复诊是由于医疗失误或最初治疗不充分,另一些人则是由于疾病进展或缺乏可获得的护理。开发风险评估工具可以识别高危患者,改善资源管理。方法:本研究透过台湾某三级医疗中心的电子病历系统进行。我们利用2019年1月至2020年12月期间接受72小时ED复诊的成年人回顾性队列,通过逻辑回归和自举方法推导了风险模型。研究人群分为开发数据集(2019:1224)和验证数据集(2020:985)。主要终点为高危复发,定义为重症监护病房(ICU)入院或ED复发72小时后的住院死亡率。结果:在优势比的基础上,8个变量与高危ED复发独立相关,随后被纳入HANDLE-24评分(高血压;急性冠脉综合征的症状;dysnatremia;呼吸困难;肝脏疾病;伤情分类级别升级;受试者工作特征曲线下面积为0.816 (95% CI: 0.760-0.871, p)。结论:HANDLE-24评分是一种简单的工具,可以进行早期风险分层,并为经历ED复诊的患者提供更积极的治疗策略。通过容易获得的信息,可以迅速评估成人ED患者重访后不良后果的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Predicting high-risk return at emergency department presentation for patients who undergo short-term revisits: the HANDLE-24 score.

Background: The 72-h emergency department (ED) revisit rate is a key quality indicator. While some revisits stem from medical errors or inadequate initial treatment, others are due to disease progression or a lack of accessible care. The development of a risk assessment tool could identify high-risk patients and improve resource management.

Methods: This study was conducted via an electronic health records system at a tertiary center in Taiwan. We derived a risk model via logistic regression and bootstrapping methods using a retrospective cohort of adults who underwent 72-h ED revisits between January 2019 and December 2020. The study population was divided into development (2019: 1224) and validation datasets (2020: 985). The primary outcome was high-risk return, defined as intensive care unit (ICU) admission or in-hospital mortality after 72-h ED return.

Results: On the basis of the odds ratio, eight variables were independently associated with high-risk ED returns and subsequently included in the HANDLE-24 score (hypertension; symptoms of acute coronary syndrome; dysnatremia; dyspnea; liver disease; triage level escalation; and revisits within 24 h). The area under the receiver operating characteristic curve was 0.816 (95% CI: 0.760-0.871, p < 0.001) in the development dataset and 0.804 (0.750-0.858) in the validation dataset. Patients can be divided into three risk categories on the basis of the HANDLE-24 score: low [0-8.5], moderate [9-11.5] and high [12-22] risk groups. The ability of our risk score to predict the rates of hospital admission, ICU admission and in-hospital mortality was significant according to the Cochran‒Armitage trend test.

Conclusion: The HANDLE-24 score represents a simple tool that allows early risk stratification and suggests more aggressive therapeutic strategies for patients experiencing ED revisits. The risk of adverse outcomes in ED adults after revisiting can be swiftly assessed via easily available information.

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来源期刊
BMC Emergency Medicine
BMC Emergency Medicine Medicine-Emergency Medicine
CiteScore
3.50
自引率
8.00%
发文量
178
审稿时长
29 weeks
期刊介绍: BMC Emergency Medicine is an open access, peer-reviewed journal that considers articles on all urgent and emergency aspects of medicine, in both practice and basic research. In addition, the journal covers aspects of disaster medicine and medicine in special locations, such as conflict areas and military medicine, together with articles concerning healthcare services in the emergency departments.
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