描述到急诊科(ED)就诊并诊断为创伤性脑损伤(TBI)的成年人的就诊率和就诊率。TBI是美国死亡和残疾的主要原因,目前的文献是有限的,因为很少有研究在广泛的损伤严重程度范围内检查TBI患者的长期ED再就诊和医院再入院模式,这可以帮助告知潜在的未满足的医疗保健需求。
我们进行了一项回顾性队列研究。
我们分析了加州全州健康规划和发展办公室2005年至2014年的非公开患者水平数据。
我们确定了120万名年龄≥18岁的成年患者,他们在加州ED和医院就诊,诊断为TBI。
我们的主要成果包括重访,随着时间的推移,再入院和死亡率。我们还研究了人口统计学,损伤的机制和严重程度以及出院时的处置。
我们发现TBIED访问次数增加了57.7%,在10年期间,TBI就诊率增加了40.5%(每10万居民346-487)。在此期间,入院的患者比例也下降了33.8%。年纪更大,公共保险和黑人人口的访问率最高,跌倒是最常见的损伤机制(占访视的45.5%).在所有有索引性TBI就诊的患者中,40.5%的人在第一年有重访,其中46.7%的人在与最初的医院或ED就诊不同的医院寻求护理。此外,第一年内的重访,其中13.4%导致再次住院。
大部分TBI患者直接从ED出院,再访问和再入院率很高,建议既定的后续行动系统的作用,TBI的治疗和护理。
To describe visits and visit rates of adults presenting to emergency departments (EDs) with a diagnosis of traumatic brain injury (TBI). TBI is a major cause of death and disability in the USA; yet, current literature is limited because few studies examine longer-term ED revisits and hospital readmission patterns of TBI patients across a broad spectrum of injury severity, which can help inform potential unmet healthcare needs.
We performed a retrospective cohort
study.
We analysed non-public patient-level data from California\'s Office of Statewide Health Planning and Development for years 2005 to 2014.
We identified 1.2 million adult patients aged ≥18 years presenting to California EDs and hospitals with an index diagnosis of TBI.
Our main outcomes included revisits, readmissions and mortality over time. We also examined demographics, mechanism and severity of injury and disposition at discharge.
We found a 57.7% increase in the number of TBI ED visits, representing a 40.5% increase in TBI visit rates over the 10-year period (346-487 per 100 000 residents). During this time, there was also a 33.8% decrease in the proportion of patients admitted to the hospital. Older, publicly insured and black populations had the highest visit rates, and falls were the most common mechanism of injury (45.5% of visits). Of all patients with an index TBI visit, 40.5% of them had a revisit during the first year, with 46.7% of them seeking care at a different hospital from their initial hospital or ED visit. Additionally, of revisits within the first year, 13.4% of them resulted in hospital readmission.
The large proportion of patients with TBI who are discharged directly from the ED, along with the high rates of revisits and readmissions, suggest a role for an established system for follow-up, treatment and care of TBI.