Pattern of Investigation Reflects Risk Profile in Emergency Medical Admissions

Journal of Clinical Medicine

Deirdre O'Riordan¹  Bernard Silke¹  Declan Byrne¹  Seán Cournane²  Niall Sheehy³ 

[1] Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland;Department of Medical Physics and Bioengineering, St James's Hospital, Dublin 8, Ireland;Diagnostic Imaging Department, St. James's Hospital, Dublin 8, Ireland;

关键词: resource utilization;    in-hospital mortality;    emergency medical admissions;   

DOI  :  10.3390/jcm4051113

来源: DOAJ

【 摘 要 】

Demand for hospital resources may increase over time; we have examined all emergency admissions (51,136 episodes) from 2005 to 2013 for underlying trends and whether resource utilization and clinical risk are correlated. We used logistic regression of the resource indicator against 30-day in-hospital mortality and adjusted this risk estimate for other outcome predictors. Generally, resource indicators predicted an increased risk of a 30-day in-hospital death. For CT Brain the Odds Ratio (OR) was 1.37 (95% CI: 1.27, 1.50), CT Abdomen 3.48 (95% CI: 3.02, 4.02) and CT Chest, Thorax, Abdomen and Pelvis 2.50 (95% CI: 2.10, 2.97). Services allied to medicine including Physiotherapy 2.57 (95% CI: 2.35, 2.81), Dietetics 2.53 (95% CI: 2.27, 2.82), Speech and Language 5.29 (95% CI: 4.57, 6.05), Occupational Therapy 2.65 (95% CI: 2.38, 2.94) and Social Work 1.65 (95% CI: 1.48, 1.83) all predicted an increased risk. The in-hospital 30-day mortality increased with resource utilization, from 4.7% (none) to 27.0% (five resources). In acute medical illness, the use of radiological investigations and allied professionals increasedover time. Resource utilization was calibrated from case complexity/30-day in-hospitalmortality suggesting that complexity determined the need for and validated the use ofthese resources.

【 授权许可】

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