■指南和风险评分旨在规范急诊科(ED)晕厥的管理,但在实践中的变化仍然存在。
■本研究的目的是探讨低风险晕厥的ED患者的入院相关因素。
■我们的研究人群包括2006年至2019年全国急诊科样本中的成年患者,这些患者被诊断为晕厥。多变量分层逻辑回归分析确定了患者或医院因素与入院的关联。参考效应测量方法评估了患者的相对贡献,医院,和无法衡量的医院因素。
■在研究期间的3,206,739次排位赛中,804398(25.1%)符合低风险标准。在这些病人中,20,260人入院(2.5%)。与入院几率增加相关的因素包括年龄增加和周末到医院就诊,而女性性行为,缺乏医疗保险,医院区域,教学现状,较高的ED体积十分位数与较低的入院几率相关。参考效应测量方法表明,与复合患者(OR0.33-3.68)或医院(OR0.65-1.30)因素相比,未测量的部位变异性对入院几率的影响最大(比值比[OR]第5百分位数与第95百分位数0.23-4.38)。
■低风险晕厥的入院模式因机构而异。未测量的地点变化对入院率的变化有显著的贡献,提示患者选择哪家医院在入院决策中起着不成比例的作用。需要进一步的指导,以减少ED中晕厥护理的实践差异。
UNASSIGNED: Guidelines and risk scores have sought to standardize the management of
syncope in the emergency department (ED), but variation in practice remains.
UNASSIGNED: The purpose of this study was to explore factors associated with admission for patients presenting to the ED with low-risk
syncope.
UNASSIGNED: Our study population included adult patients in the Nationwide Emergency Department Sample between 2006 and 2019 who presented to an ED with a primary diagnosis of
syncope. Multivariable hierarchical logistic regression analyses determined the association of patient or hospital factors with admission. Reference effect measures methodology assessed the relative contributions of patient, hospital, and unmeasured hospital factors.
UNASSIGNED: Of the 3,206,739 qualifying encounters during the study period, 804,398 (25.1%) met low-risk criteria. Of these patients, 20,260 were admitted to the hospital (2.5%). Factors associated with increased odds of admission included increasing age and weekend presentation to the hospital, while female sex, lack of medical insurance, hospital region, teaching status, and higher ED volume decile were associated with lower odds of admission. Reference effect measures methodology demonstrated that unmeasured site variability contributed the widest range of odds for admission (odds ratio [OR] 5th percentile vs 95th percentile 0.23-4.38) compared with the composite patient (OR 0.33-3.68) or hospital (OR 0.65-1.30) factors.
UNASSIGNED: Admission patterns for low-risk
syncope varies widely across institutions. Unmeasured site variation contributes significantly to the variability in admission rates, suggesting which hospital a patient presents to plays a disproportionate role in admission decisions. Further guidance to reduce practice variation in
syncope care in the ED is needed.