简介由于精神健康障碍的患病率增加,在美国,急诊科(ED)用于管理精神病紧急情况的利用率显着增加。这项研究使用来自全国急诊科样本(NEDS)的数据,调查了针对精神病紧急情况的ED就诊的全国病例量和性别差异。方法这项回顾性分析包括使用相关国际疾病分类确定的成人ED就诊,第十次修订(ICD-10)代码。主要终点包括按性别分列的全国病例量。年龄<18岁的住院患者和性别数据缺失的患者被排除在外。次要终点包括住院死亡率,ED和住院费用,录取率,放电处理,停留时间(LOS)和程序的数量。结果2021年,美国约有1.435亿例ED访问,其中7,978,490用于精神病紧急情况。最常见的表现是药物滥用和中毒(5,119,086(64.2%)),严重的双相情感障碍(1,912,670(24%)),和焦虑或恐慌症发作(1,015,486(12.7%))。大约3,997,223(50.1%)是女性,男性为3981267人(49.9%)。男性年龄较大(平均年龄:45岁对43岁;P<0.001),更有可能没有保险(712,647(17.9%)对497,658(12.5%);P<0.001),Charlson合并症指数(CCI)较高(CCI≥2:792,272(19.9%)对643,552(16.1%);P<0.001)。接受急性药物滥用或中毒的男性多于女性(3,196,945(80.3%)与1,922,142(48.1%)),伴有或不伴有精神病的双相情感障碍(958,275(24.1%)与954,395(23.9%);P<0.001),和自杀意念(267,638(6.7%)对208,989(5.2%);P<0.001)。患有严重抑郁症的女性多于男性(455,683(11.4%)与441,921(11.1%)),焦虑和惊恐发作(615,572(15.4%)对402,108(10.1%)),急性应激反应(35,975(0.9%)与23,888(0.6%)),饮食失调(3,997(0.1%)与27,869(0.07%)),滥用史(21,164(0.53%)对19,569(0.49%);P<0.001)。妇女的死亡率较低(27,980(0.7%)对63,956(1.6%);P<0.001),较低的平均ED成本(调整后平均差(AMD):1189美元;P<0.001),住院人数较少(1,211,158(30.3%)与1,453,162(36.5%);P<0.001),与男性相比,长期住院的人数更高(1,442,998(36.1%)与1,194,380(30%);P<0.001)。结论这项研究强调了在精神病紧急情况下ED利用方面的显着性别差异。男性更常出现药物滥用和严重合并症,导致更高的医疗成本和住院。女人,虽然更有可能出现焦虑和抑郁障碍,产生更低的成本和更好的整体结果。
Introduction The utilization of emergency departments (EDs) for managing psychiatric emergencies has significantly increased in the United States because of the increasing prevalence of mental health disorders. This study examined national case volumes and sex disparities in ED visits for psychiatric emergencies using data from the Nationwide Emergency Department Sample (NEDS). Methods This retrospective analysis included adult ED visits for psychiatric emergencies identified using relevant International Classification of Diseases, 10th Revision (ICD-10) codes. Primary endpoints included national case volumes by sex. Hospitalizations with age < 18 years and those with missing data on sex were excluded. Secondary endpoints included inpatient mortality, ED and inpatient costs, admission rates, discharge disposition, length of stay (LOS), and number of procedures. Results In 2021, there were approximately 143.5 million ED visits in the United States, with 7,978,490 of these being for psychiatric emergencies. The most common presentations were substance abuse and intoxication (5,119,086 (64.2%)), severe bipolar disorder (1,912,670 (24%)), and anxiety or panic attacks (1,015,486 (12.7%)). Approximately 3,997,223 (50.1%) were women, and 3,981,267 (49.9%) were men. Men were older (mean age: 45 versus 43 years; P<0.001), were more likely to be uninsured (712,647 (17.9%) versus 497,658 (12.5%); P<0.001), and had a higher Charlson Comorbidity Index (CCI) (CCI ≥ 2: 792,272 (19.9%) versus 643,552 (16.1%); P<0.001). More men than women presented to the ED with acute substance abuse or intoxication (3,196,945 (80.3%) versus 1,922,142 (48.1%)), bipolar disorder with or without psychosis (958,275 (24.1%) versus 954,395 (23.9%); P<0.001), and suicidal ideation (267,638 (6.7%) versus 208,989 (5.2%); P<0.001). More women than men presented with severe depression (455,683 (11.4%) versus 441,921 (11.1%)), anxiety and panic attacks (615,572 (15.4%) versus 402,108 (10.1%)), acute stress reaction (35,975 (0.9%) versus 23,888 (0.6%)), eating disorders (3,997 (0.1%) versus 27,869 (0.07%)), and a history of abuse (21,164 (0.53%) versus 19,569 (0.49%); P<0.001). Women had lower mortality rates (27,980 (0.7%) versus 63,956 (1.6%); P<0.001), lower mean ED costs (adjusted mean difference (AMD): $1,189; P<0.001), fewer in-hospital admissions (1,211,158 (30.3%) versus 1,453,162 (36.5%); P<0.001), and a higher number of prolonged hospitalizations (1,442,998 (36.1%) versus 1,194,380 (30%); P<0.001) compared with men. Conclusion This study highlights significant sex disparities in ED utilization for psychiatric emergencies. Men more frequently present with substance abuse and severe comorbidities, leading to higher healthcare costs and inpatient admissions. Women, while more likely to present with anxiety and depressive disorders, incur lower costs and have better overall outcomes.