山东省某三甲医院2004-2014年急诊患者病死率研究

目的：研究一家大型综合性三甲医院急诊科2004—2014年患者病死率变化，并分析其可能的影响因素。方法统计2004年、2009年和2014年该院急诊科就诊人次及死亡患者人数，计算病死率，并收集上述3年全部死亡患者临床资料，采用方差分析和χ2检验对数据进行分析。结果2004—2014年，该院急诊患者数量显著增加（2014年较2004年增加了38.0％，抢救和留观人数增加71.6％），病死率总体呈上升趋势（2004年 0.3％，2009年 0.8％，2014年 0.7％，P ＜0.01），纳入上述3年共1091例死亡患者进行分析。基线临床特征：男：女比例为1.36∶1，该比例2004—2014年间无显著变化；平均寿命61.9岁，过去10年亦无显著变化。救治条件：该院急诊科医护人员数量和硬件设施配备均有明显提升。流行病学特点：心、脑血管疾病和猝死是急诊死亡三大主要原因，三者所占总比例以及外伤、肿瘤等各自所占比例2004—2014年均无显著变化。急救意识：发病至急诊就诊时间2004—2014年无显著变化，救护车应用比例未发生改变；患者家属配合抢救的比例显著下降（2004年 61.1％，2009年 60.2％，2014年 42.8％，P ＜0.01）。时间分布：急诊死亡患者就诊的节假日分布、昼夜班次分布均无显著变化，平均急诊滞留时间明显上升（2004年 22.4 h，2014年 39.3 h，P ＝0.02）。结论2004—2014年间，尽管急诊科硬件设施和人员配备得到显著改善，急诊患者病死率仍呈上升趋势，这一状况可能与就诊患者数量（尤其是危重患者数量）大幅度增加、病患自我急救意识无改善、对急诊救治的配合程度显著下降、急诊滞留时间显著增加等相关。

A retrospective study of emergency department mortality of a tertiary general hospital from 2004 to 2014 in Shandong province

Objective To determine the trend of emergency department (ED)mortality of a tertiary general hospital from 2004 to 2014 in order to find the factors that may impact on ED mortality.Methods Mortality in ED was estimated according to the ratio of ED visiting patients to ED deaths.And the data of all ED deaths in 2004,2009 and 2014 were collected.Variance analysis and chi-square test were used for data analysis.Results During the past decade,ED visiting patients was increased significantly by 38.0% in 2014,compared with those in 2004,and the mortality was also increased accordingly from 0.7% in 2004, to 0.9% in 2009,to 1.2% in 2014 (P <0.01).Finally,a total of 1,091 deaths occurred in these three years were included for further evaluation.There were no significant changes in average age and gender distribution,and the average age was 61.9 and the male /female ratio was 1.36∶1 during past decade.The number of adults under 40 years old (18 -39)increased from 7.5% in 2004,to 10.6% in 2009,to 14.4% in 2014 (P <0.05).Both the facilities were upgraded and the number of staffs in ED increased markedly.The cardiovascular illness,cerebrovascular diseases,and sudden death were the leading causes of ED death during past decade.The incidences of trauma and tumor remained unchanged.Average time consumed from onset of illness to arrival to ED didn’t vary significantly during past decade.The study showed no changes in use of ambulance,but remarkable increases in number of non-compliant patients or their family from 18.3% in 2004,to 25.6% in 2009,to 38.3% in 2014 (P <0.01).The percentage of patients in the night time was higher,but there were no significant changes in number of emergency patients in the night time and during holidays in the past decade,but the mean ED stay time increased obviously from 22.4 h in 2004 to 53.3 h in 2014 (P <0.05 ).Conclusions During the past decade,although ED facilities and number of staffs have been improved apparently,ED mortality rate still keeps on escalating. The increase in ED mortality rate may be related to the severely ill patients presenting to ED,the obvious decrease in compliance of patients and the prolonged ED stay time.