Casey Marnie, Anja Vorster, Claire Harris, A M Margaret Fry, David Lim, Eamon Merrick
{"title":"28天后：急诊诊断与再入院风险增加相关，一项针对老年人的回顾性观察研究","authors":"Casey Marnie, Anja Vorster, Claire Harris, A M Margaret Fry, David Lim, Eamon Merrick","doi":"10.1111/jocn.70097","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>To describe diagnostic categories and comorbidities associated with increased risk of readmission within 28 days among older adults.</p><p><strong>Methods: </strong>Retrospective observational study of all hospital admissions following ED attendance by patients aged ≥ 60 years between July 2020 and June 2023. Index and subsequent 28-day readmission were identified using ED data and hospital discharge records. ED diagnosis, Australian Refined Diagnosis-Related Group (AR-DRG) discharge codes, and ICD-10-AM comorbidities were extracted. Multivariate logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations with 28-day readmission. The study and findings have been reported against the STROBE-RECORD guideline.</p><p><strong>Results: </strong>Of the 28,730 initial patient visits, 7.9% re-presented within 28 days. The most common ED diagnoses at initial and readmission were chest pain (5.4% vs. 4.6%), falls (5.2% vs. 4.1%), dyspnoea (3.5% vs. 3.1%), abdominal pain (3.1% vs. 3.3%) and cerebrovascular accident (1.7% vs. 1.7%). The most frequent AR-DRGs were respiratory infections/inflammations, kidney and urinary signs/symptoms, and other digestive system disorders. Key ICD-10-AM codes associated with a higher likelihood of readmission within 28 days were obstructive/reflux uropathy (OR 2.66, 95% CI 1.78-3.96), urinary retention (OR 1.84, 95% CI 1.38-2.46), chronic ischaemic heart disease (OR 1.57, 95% CI 1.10-2.25), delirium (OR 1.35, 95% CI 1.07-1.71) and disorders of fluid, electrolyte, and acid-base balance (OR 1.29, 95% CI 1.09-1.54).</p><p><strong>Conclusion: </strong>Nearly 8% of older adults are readmitted within 28 days. Our described approach offers a potential framework to identify at-risk groups and intervene to reduce avoidable representations and/or admissions.</p><p><strong>Relevance to clinical practice: </strong>The results reported here create the opportunity for clinicians to identify areas for improvement in clinical practice, care coordination, and service delivery. Our approach and methodology can be replicated in other health services.</p><p><strong>Patient or public contribution: </strong>No patient or public contribution.</p>","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":" ","pages":""},"PeriodicalIF":3.5000,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Twenty-Eight Days Later: Emergency Diagnoses Associated With Increased Risk of Readmission, a Retrospective Observational Study of Older Adults.\",\"authors\":\"Casey Marnie, Anja Vorster, Claire Harris, A M Margaret Fry, David Lim, Eamon Merrick\",\"doi\":\"10.1111/jocn.70097\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aims: </strong>To describe diagnostic categories and comorbidities associated with increased risk of readmission within 28 days among older adults.</p><p><strong>Methods: </strong>Retrospective observational study of all hospital admissions following ED attendance by patients aged ≥ 60 years between July 2020 and June 2023. Index and subsequent 28-day readmission were identified using ED data and hospital discharge records. ED diagnosis, Australian Refined Diagnosis-Related Group (AR-DRG) discharge codes, and ICD-10-AM comorbidities were extracted. Multivariate logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations with 28-day readmission. The study and findings have been reported against the STROBE-RECORD guideline.</p><p><strong>Results: </strong>Of the 28,730 initial patient visits, 7.9% re-presented within 28 days. The most common ED diagnoses at initial and readmission were chest pain (5.4% vs. 4.6%), falls (5.2% vs. 4.1%), dyspnoea (3.5% vs. 3.1%), abdominal pain (3.1% vs. 3.3%) and cerebrovascular accident (1.7% vs. 1.7%). The most frequent AR-DRGs were respiratory infections/inflammations, kidney and urinary signs/symptoms, and other digestive system disorders. Key ICD-10-AM codes associated with a higher likelihood of readmission within 28 days were obstructive/reflux uropathy (OR 2.66, 95% CI 1.78-3.96), urinary retention (OR 1.84, 95% CI 1.38-2.46), chronic ischaemic heart disease (OR 1.57, 95% CI 1.10-2.25), delirium (OR 1.35, 95% CI 1.07-1.71) and disorders of fluid, electrolyte, and acid-base balance (OR 1.29, 95% CI 1.09-1.54).</p><p><strong>Conclusion: </strong>Nearly 8% of older adults are readmitted within 28 days. Our described approach offers a potential framework to identify at-risk groups and intervene to reduce avoidable representations and/or admissions.</p><p><strong>Relevance to clinical practice: </strong>The results reported here create the opportunity for clinicians to identify areas for improvement in clinical practice, care coordination, and service delivery. 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引用次数: 0
摘要
目的：描述与老年人28天内再入院风险增加相关的诊断类别和合并症。方法：回顾性观察研究2020年7月至2023年6月期间所有年龄≥60岁的患者在急诊科就诊后入院。使用ED数据和出院记录确定指数和随后的28天再入院。提取ED诊断、澳大利亚精细诊断相关组（AR-DRG）出院代码和ICD-10-AM合并症。使用多变量逻辑回归来估计与28天再入院相关的比值比（ORs）和95%置信区间（CIs）。这项研究和结果是根据STROBE-RECORD指南报道的。结果：在28,730例初次就诊的患者中，7.9%的患者在28天内再次就诊。初次和再入院时最常见的ED诊断是胸痛（5.4%对4.6%）、跌倒（5.2%对4.1%）、呼吸困难（3.5%对3.1%）、腹痛（3.1%对3.3%）和脑血管意外（1.7%对1.7%）。最常见的AR-DRGs是呼吸道感染/炎症、肾脏和泌尿系统体征/症状以及其他消化系统疾病。与28天内再入院可能性较高相关的关键ICD-10-AM编码是梗阻性/反流性尿病（OR 2.66, 95% CI 1.78-3.96）、尿潴留（OR 1.84, 95% CI 1.38-2.46）、慢性缺血性心脏病（OR 1.57, 95% CI 1.10-2.25）、谵妄（OR 1.35, 95% CI 1.09- 1.71）和液体、电解质和酸碱平衡紊乱（OR 1.29, 95% CI 1.09-1.54）。结论：近8%的老年人在28天内再次入院。我们所描述的方法提供了一个潜在的框架来识别风险群体，并进行干预，以减少可避免的陈述和/或入院。与临床实践的相关性：这里报告的结果为临床医生创造了机会，以确定在临床实践、护理协调和服务提供方面需要改进的领域。我们的做法和方法可以在其他卫生服务中复制。患者或公众捐款：没有患者或公众捐款。
Twenty-Eight Days Later: Emergency Diagnoses Associated With Increased Risk of Readmission, a Retrospective Observational Study of Older Adults.
Aims: To describe diagnostic categories and comorbidities associated with increased risk of readmission within 28 days among older adults.
Methods: Retrospective observational study of all hospital admissions following ED attendance by patients aged ≥ 60 years between July 2020 and June 2023. Index and subsequent 28-day readmission were identified using ED data and hospital discharge records. ED diagnosis, Australian Refined Diagnosis-Related Group (AR-DRG) discharge codes, and ICD-10-AM comorbidities were extracted. Multivariate logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations with 28-day readmission. The study and findings have been reported against the STROBE-RECORD guideline.
Results: Of the 28,730 initial patient visits, 7.9% re-presented within 28 days. The most common ED diagnoses at initial and readmission were chest pain (5.4% vs. 4.6%), falls (5.2% vs. 4.1%), dyspnoea (3.5% vs. 3.1%), abdominal pain (3.1% vs. 3.3%) and cerebrovascular accident (1.7% vs. 1.7%). The most frequent AR-DRGs were respiratory infections/inflammations, kidney and urinary signs/symptoms, and other digestive system disorders. Key ICD-10-AM codes associated with a higher likelihood of readmission within 28 days were obstructive/reflux uropathy (OR 2.66, 95% CI 1.78-3.96), urinary retention (OR 1.84, 95% CI 1.38-2.46), chronic ischaemic heart disease (OR 1.57, 95% CI 1.10-2.25), delirium (OR 1.35, 95% CI 1.07-1.71) and disorders of fluid, electrolyte, and acid-base balance (OR 1.29, 95% CI 1.09-1.54).
Conclusion: Nearly 8% of older adults are readmitted within 28 days. Our described approach offers a potential framework to identify at-risk groups and intervene to reduce avoidable representations and/or admissions.
Relevance to clinical practice: The results reported here create the opportunity for clinicians to identify areas for improvement in clinical practice, care coordination, and service delivery. Our approach and methodology can be replicated in other health services.
Patient or public contribution: No patient or public contribution.
期刊介绍：
The Journal of Clinical Nursing (JCN) is an international, peer reviewed, scientific journal that seeks to promote the development and exchange of knowledge that is directly relevant to all spheres of nursing practice. The primary aim is to promote a high standard of clinically related scholarship which advances and supports the practice and discipline of nursing. The Journal also aims to promote the international exchange of ideas and experience that draws from the different cultures in which practice takes place. Further, JCN seeks to enrich insight into clinical need and the implications for nursing intervention and models of service delivery. Emphasis is placed on promoting critical debate on the art and science of nursing practice.
JCN is essential reading for anyone involved in nursing practice, whether clinicians, researchers, educators, managers, policy makers, or students. The development of clinical practice and the changing patterns of inter-professional working are also central to JCN''s scope of interest. Contributions are welcomed from other health professionals on issues that have a direct impact on nursing practice.
We publish high quality papers from across the methodological spectrum that make an important and novel contribution to the field of clinical nursing (regardless of where care is provided), and which demonstrate clinical application and international relevance.
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