PDF(Pubmed)
Abstract：
BACKGROUND: Substance misuse poses a significant public health challenge, characterized by premature morbidity and mortality, and heightened healthcare utilization. While studies have demonstrated that previous hospitalizations and emergency department visits are associated with increased mortality in patients with substance misuse, it is unknown whether prior utilization of emergency medical service (EMS) is similarly associated with poor outcomes among this population. The objective of this study is to determine the association between EMS utilization in the 30 days before a hospitalization or emergency department visit and in-hospital outcomes among patients with substance misuse.
METHODS: We conducted a retrospective analysis of adult emergency department visits and hospitalizations (referred to as a hospital encounter) between 2017 and 2021 within the Substance Misuse Data Commons, which maintains electronic health records from substance misuse patients seen at two University of Wisconsin hospitals, linked with state agency, claims, and socioeconomic datasets. Using regression models, we examined the association between EMS use and the outcomes of in-hospital death, hospital length of stay, intensive care unit (ICU) admission, and critical illness events, defined by invasive mechanical ventilation or vasoactive drug administration. Models were adjusted for age, comorbidities, initial severity of illness, substance misuse type, and socioeconomic status.
RESULTS: Among 19,402 encounters, individuals with substance misuse who had at least one EMS incident within 30 days of a hospital encounter experienced a higher likelihood of in-hospital mortality (OR 1.52, 95% CI [1.05 - 2.14]) compared to those without prior EMS use, after adjusting for confounders. Using EMS in the 30 days prior to an encounter was associated with a small increase in hospital length of stay but was not associated with ICU admission or critical illness events.
CONCLUSIONS: Individuals with substance misuse who have used EMS in the month preceding a hospital encounter are at an increased risk of in-hospital mortality. Enhanced monitoring of EMS users in this population could improve overall patient outcomes.
METHODS: We conducted a retrospective analysis of adult emergency department visits and hospitalizations (referred to as a hospital encounter) between 2017 and 2021 within the Substance Misuse Data Commons, which maintains electronic health records from substance misuse patients seen at two University of Wisconsin hospitals, linked with state agency, claims, and socioeconomic datasets. Using regression models, we examined the association between EMS use and the outcomes of in-hospital death, hospital length of stay, intensive care unit (ICU) admission, and critical illness events, defined by invasive mechanical ventilation or vasoactive drug administration. Models were adjusted for age, comorbidities, initial severity of illness, substance misuse type, and socioeconomic status.
RESULTS: Among 19,402 encounters, individuals with substance misuse who had at least one EMS incident within 30 days of a hospital encounter experienced a higher likelihood of in-hospital mortality (OR 1.52, 95% CI [1.05 - 2.14]) compared to those without prior EMS use, after adjusting for confounders. Using EMS in the 30 days prior to an encounter was associated with a small increase in hospital length of stay but was not associated with ICU admission or critical illness events.
CONCLUSIONS: Individuals with substance misuse who have used EMS in the month preceding a hospital encounter are at an increased risk of in-hospital mortality. Enhanced monitoring of EMS users in this population could improve overall patient outcomes.
摘要：
背景：物质滥用构成了重大的公共卫生挑战，以过早的发病率和死亡率为特征，提高医疗保健利用率。虽然研究表明，以前的住院和急诊就诊与药物滥用患者的死亡率增加有关，在该人群中,先前使用急诊医疗服务(EMS)是否与不良结局类似相关尚不清楚.这项研究的目的是确定住院或急诊科就诊前30天内的EMS利用率与药物滥用患者的住院结局之间的关系。
方法：我们在物质滥用数据共享范围内对2017年至2021年成人急诊科就诊和住院（称为医院遭遇）进行了回顾性分析。它保存了在威斯康星大学两家医院看到的药物滥用患者的电子健康记录，与国家机构有联系，索赔,和社会经济数据集。使用回归模型，我们检查了EMS使用与院内死亡结果之间的关系，住院时间,重症监护病房(ICU)入院,和危重疾病事件，定义为有创机械通气或血管活性药物给药。模型根据年龄进行了调整，合并症,最初的疾病严重程度，物质误用类型,和社会经济地位。
结果：在19,402次相遇中，与之前未使用过EMS的患者相比,在医院治疗后30天内至少发生过一次EMS事件的患者发生院内死亡的可能性更高(OR1.52,95%CI[1.05-2.14]),在对混杂因素进行调整后。在相遇前30天使用EMS与住院时间略有增加有关，但与ICU入院或危重疾病事件无关。
结论：在住院前一个月内使用过EMS的药物滥用者，其院内死亡风险增加。增强对该人群中EMS用户的监测可以改善总体患者预后。
方法：我们在物质滥用数据共享范围内对2017年至2021年成人急诊科就诊和住院（称为医院遭遇）进行了回顾性分析。它保存了在威斯康星大学两家医院看到的药物滥用患者的电子健康记录，与国家机构有联系，索赔,和社会经济数据集。使用回归模型，我们检查了EMS使用与院内死亡结果之间的关系，住院时间,重症监护病房(ICU)入院,和危重疾病事件，定义为有创机械通气或血管活性药物给药。模型根据年龄进行了调整，合并症,最初的疾病严重程度，物质误用类型,和社会经济地位。
结果：在19,402次相遇中，与之前未使用过EMS的患者相比,在医院治疗后30天内至少发生过一次EMS事件的患者发生院内死亡的可能性更高(OR1.52,95%CI[1.05-2.14]),在对混杂因素进行调整后。在相遇前30天使用EMS与住院时间略有增加有关，但与ICU入院或危重疾病事件无关。
结论：在住院前一个月内使用过EMS的药物滥用者，其院内死亡风险增加。增强对该人群中EMS用户的监测可以改善总体患者预后。
