目的上消化道出血是急诊科常见的消化道疾病,识别适合门诊治疗的低危患者,是临床和研究的重点。我们的目的是建立一个简单的预测模型来识别可以避免住院的上消化道出血患者,从而为急诊医生的分诊提供一个可行的依据。方法回顾性分析2015...目的上消化道出血是急诊科常见的消化道疾病,识别适合门诊治疗的低危患者,是临床和研究的重点。我们的目的是建立一个简单的预测模型来识别可以避免住院的上消化道出血患者,从而为急诊医生的分诊提供一个可行的依据。方法回顾性分析2015年1月至2020年12月在东南大学附属中大医院治疗的上消化道出血患者。记录患者的一般资料和首次就诊时的临床参数,采用多因素logistic回归模型确定安全出院的预测因素。结果612/1334例(45.9%)患者非安全出院。安全出院组和非安全出院组在年龄、察尔逊氏共病指数、收缩压、脉率、血红蛋白、白蛋白、血尿素氮、肌酐、国际标准化比值等方面差异有统计学意义(P<0.05)。应用多因素logistic回归分析,7个变量被纳入上消化道出血危险分层的临床预测模型:察尔逊氏共病指数>2、收缩压<90 mmHg、血红蛋白<10 g/dL、尿素氮≥6.5mmol/L、白蛋白<30 g/L、脉搏≥100次/min和国际标准化比值≥1.5。其最佳cutoff值≥1预测非安全出院的敏感性为98.37%,特异度为24.10%,阳性预测值为52.3%,阴性预测值为94.6%;受试者工作特征曲线下面积AUCROC(the area under the receiver operating characteristic curve)为0.822,显著高于Glasgow Blatchford score(GBS)0.786(95%CI 0.752~0.820,P<0.01)和AIMS650.676(95%CI 0.638~0.714,P<0.01)。结论预测评估模型具有可靠的预测价值,可为急诊医务人员分诊治疗上消化道出血患者提供参考依据,从而减少医疗开支,具有一定的社会经济效益。展开更多
Aim: Review of presentation, management and outcome of patients admitted with Diabetic Ketoacidosis (DKA) to an emergency department short stay unit with expedited discharge. Methods: All admitted patients with a disc...Aim: Review of presentation, management and outcome of patients admitted with Diabetic Ketoacidosis (DKA) to an emergency department short stay unit with expedited discharge. Methods: All admitted patients with a discharge diagnosis of “Diabetic Ketoacidosis”, were identified by the file auditing section in the Emergency Department. Data obtained from the medical records were collected using an explicit chart review from January 2012 to June 2013. Data included clinical monitoring, investigations performed, the type and amount of intravenous fluids given, the insulin regime, potassium supplementation and outcome. Results: Out of a total of 120 patients labelled as DKA or hyperglycaemia on arrival, hundred patients fulfilled the criteria for DKA. In the population studied the mean age was 25 years with a male predominance. Eighty-two patients suffered from Type 1 Diabetes Mellitus (T1DM) whilst eighteen patients had Type 2 Diabetes Mellitus (T2DM). Sixteen patients were newly diagnosed during the present admission. Seventy-six (76%) patients were on insulin. The insulin regimen and potassium supplementation were followed as per protocol in all patients. All the patients except one were given intravenous fluid according to protocol. Parameters were monitored adequately except fluid input and output monitoring. The median length of stay in the short stay unit was 1.5833 days. There was no return visit within one week of discharge. Conclusion: The median length of stay was short and there were no documented complications or deaths during the stay. There was poor compliance with documentation of fluid input and output. In this population, the short stay model of care appeared to be safe and efficient.展开更多
The Paediatric Observation Priority Score (POPS) is a bespoke assessment tool for use in Paediatric Emergency Departments incorporating traditional physiological parameters alongside more subjective observational crit...The Paediatric Observation Priority Score (POPS) is a bespoke assessment tool for use in Paediatric Emergency Departments incorporating traditional physiological parameters alongside more subjective observational criteria. Initial performance characteristics of POPS were analysed in a convenience sample of 936 presentations to ED. Triage on the basis of gut instinct parameters identified an additional 261 patients deemed of lowest acuity compared to analysis by physiology scores. Resource consumption increased with increasing acuity on presentation. POPS shows promise in assisting in the assessment process of children presenting to Emergency Departments. Inclusion of subjective triage criteria helps contextualise the physiological parameter scoring by using the experience of staff conducting triage. Initial interpretation of presenting physiology gives a more informed assessment of initial acuity, and thus is better able to identify a child who can be safely managed in the community. The system also allows for rapid detection of those most unwell.展开更多
文摘目的上消化道出血是急诊科常见的消化道疾病,识别适合门诊治疗的低危患者,是临床和研究的重点。我们的目的是建立一个简单的预测模型来识别可以避免住院的上消化道出血患者,从而为急诊医生的分诊提供一个可行的依据。方法回顾性分析2015年1月至2020年12月在东南大学附属中大医院治疗的上消化道出血患者。记录患者的一般资料和首次就诊时的临床参数,采用多因素logistic回归模型确定安全出院的预测因素。结果612/1334例(45.9%)患者非安全出院。安全出院组和非安全出院组在年龄、察尔逊氏共病指数、收缩压、脉率、血红蛋白、白蛋白、血尿素氮、肌酐、国际标准化比值等方面差异有统计学意义(P<0.05)。应用多因素logistic回归分析,7个变量被纳入上消化道出血危险分层的临床预测模型:察尔逊氏共病指数>2、收缩压<90 mmHg、血红蛋白<10 g/dL、尿素氮≥6.5mmol/L、白蛋白<30 g/L、脉搏≥100次/min和国际标准化比值≥1.5。其最佳cutoff值≥1预测非安全出院的敏感性为98.37%,特异度为24.10%,阳性预测值为52.3%,阴性预测值为94.6%;受试者工作特征曲线下面积AUCROC(the area under the receiver operating characteristic curve)为0.822,显著高于Glasgow Blatchford score(GBS)0.786(95%CI 0.752~0.820,P<0.01)和AIMS650.676(95%CI 0.638~0.714,P<0.01)。结论预测评估模型具有可靠的预测价值,可为急诊医务人员分诊治疗上消化道出血患者提供参考依据,从而减少医疗开支,具有一定的社会经济效益。
文摘Aim: Review of presentation, management and outcome of patients admitted with Diabetic Ketoacidosis (DKA) to an emergency department short stay unit with expedited discharge. Methods: All admitted patients with a discharge diagnosis of “Diabetic Ketoacidosis”, were identified by the file auditing section in the Emergency Department. Data obtained from the medical records were collected using an explicit chart review from January 2012 to June 2013. Data included clinical monitoring, investigations performed, the type and amount of intravenous fluids given, the insulin regime, potassium supplementation and outcome. Results: Out of a total of 120 patients labelled as DKA or hyperglycaemia on arrival, hundred patients fulfilled the criteria for DKA. In the population studied the mean age was 25 years with a male predominance. Eighty-two patients suffered from Type 1 Diabetes Mellitus (T1DM) whilst eighteen patients had Type 2 Diabetes Mellitus (T2DM). Sixteen patients were newly diagnosed during the present admission. Seventy-six (76%) patients were on insulin. The insulin regimen and potassium supplementation were followed as per protocol in all patients. All the patients except one were given intravenous fluid according to protocol. Parameters were monitored adequately except fluid input and output monitoring. The median length of stay in the short stay unit was 1.5833 days. There was no return visit within one week of discharge. Conclusion: The median length of stay was short and there were no documented complications or deaths during the stay. There was poor compliance with documentation of fluid input and output. In this population, the short stay model of care appeared to be safe and efficient.
文摘The Paediatric Observation Priority Score (POPS) is a bespoke assessment tool for use in Paediatric Emergency Departments incorporating traditional physiological parameters alongside more subjective observational criteria. Initial performance characteristics of POPS were analysed in a convenience sample of 936 presentations to ED. Triage on the basis of gut instinct parameters identified an additional 261 patients deemed of lowest acuity compared to analysis by physiology scores. Resource consumption increased with increasing acuity on presentation. POPS shows promise in assisting in the assessment process of children presenting to Emergency Departments. Inclusion of subjective triage criteria helps contextualise the physiological parameter scoring by using the experience of staff conducting triage. Initial interpretation of presenting physiology gives a more informed assessment of initial acuity, and thus is better able to identify a child who can be safely managed in the community. The system also allows for rapid detection of those most unwell.
