Emergency management of atrial fibrillation

Atrial fibrillation is the most common cardiac arrhythmia managed by emergency and acute general physicians. There is increasing evidence that selected patients with acute atrial fibrillation can be safely managed in the emergency department without the need for hospital admission. Meanwhile, there is significant variation in the current emergency management of acute atrial fibrillation. This review discusses evidence based emergency management of atrial fibrillation. The principles of emergency management of acute atrial fibrillation and the subset of patients who may not need hospital admission are reviewed. Finally, the need for evidence based guidelines before emergency department based clinical pathways for the management of acute atrial fibrillation becomes routine clinical practice is highlighted.     

消化道出血诱发急性心肌梗死的临床分析

目的 分析消化道出血诱发急性心肌梗死的临床特点及死亡相关危险因素,提高医务人员对此类此病的诊治水平。方法 回顾性分析2015年1月~2017年1月于武汉大学人民医院就诊的消化道出血诱发急性心肌梗死的28例患者的一般资料、临床表现、实验室检查、心电图变化、治疗及预后情况等,按照患者预后情况,分为生存组（13例）和死亡组（15例）,分析影响患者预后的相关因素。结果 28例消化道出血诱发急性心肌梗死患者中,其中男性24例,女性4例,患者平均年龄70.8±11.0岁;有5例表现呕血,有8例表现黑便;有13例表现同时表现呕血与黑便,有2例表现为呕吐咖啡样胃内容物;诱发急性心肌梗死时,仅有6例表现为典型胸痛,有4例表现为心慌、胸闷,有18例无明显症状;所有患者中,急性非ST段抬高型心肌梗死21例（75.0%）,急性ST段抬高型心肌梗死7例（25.0%）,其中广泛前壁合并下壁梗死2例（7.1%）,广泛前壁梗死7例（25.0%）,下壁梗死13例（46.4%）,前壁梗死5例（17.9%）,后壁梗死1例（3.6%）;经治疗,有13例好转,15例死亡。重度贫血及肝硬化病史在生存组及死亡组两组患者中的差异有统计学意义,Logistics回归分析发现重度贫血（OR=11.67,P=0.018）是患者死亡的独立危险因素。结论 消化道出血诱发急性心肌梗死时多无胸痛等典型心肌梗死症状,且多表现为非ST段抬高型心肌梗死,此类患者病情危重,病死率高,重度贫血是此类患者死亡的独立危险因素。     

急性ST段抬高心肌梗死患者行急诊冠状动脉介入治疗术中无复流影响因素分析

目的 探讨急性ST段抬高心肌梗死（ST-segment elevation myocardial infarction,STEMI）患者行急诊冠状动脉介入术（percutaneous coronary intervention,PCI）中发生无复流的影响因素。方法 将2012年6月至2013年1月本院收治的行急诊PCI治疗的急性STEMI患者（n=92）,分为正常复流组（n=73）和无复流组（n=19）。通过比较两组的临床症状来分析无复流发生的相关影响因素。结果 急性STEMI患者行急诊PCI后无复流发生率为20.7%（19/92）,无复流组与正常复流组相比,两组之间入院时的收缩压（SBP）、2型糖尿病患病数、肌钙蛋白T峰值、发病到再灌注时间、球囊扩张次数和靶血管植入支架数量差异均有统计学意义（P<0.05）;经多因素logistic 回归分析显示入院SBP<100 mmHg （1 mmHg=0.133 kPa）、合并2型糖尿病、球囊扩张次数、肌钙蛋白T峰值、右冠状动脉病变和发病至再灌注时间是急诊PCI术后无复流发生的危险因素。结论 急性STEMI患者行急诊PCI后无复流发生与入院SBP<100 mmHg、合并2型糖尿病、球囊扩张次数、肌钙蛋白T峰值、右冠状动脉病变及发病至再灌注时间这6种临床因素具有相关性。     

乳酸左氧氟沙星与头孢唑肟在急性水肿型胆源性胰腺炎抗感染治疗中的疗效对比

【】　目的　观察并对比乳酸左氧氟沙星/头孢唑肟在急性水肿型胆源性胰腺炎治疗中的效果,为急性胰腺炎的临床规范抗感染治疗提供参考。方法　选取2014年1月至2014年11月期间在本院急诊科病区连续收治的180例急性水肿型胆源性胰腺炎患者,随机分为乳酸左氧氟沙星治疗组与头孢唑肟治疗组,在禁食水、胃肠减压、抑酸、抑酶、营养支持等常规治疗基础上分别选用乳酸左氧氟沙星及头孢唑肟抗感染,监测患者呕吐、腹痛、腹胀缓解情况及时间,开放饮食时间,住院天数,血常规、C反应蛋白（CRP）、生化、血清淀粉酶变化及影像学中胰腺炎症吸收情况。结果　乳酸左氧氟沙星治疗组总有效率高于头孢唑肟治疗组（P＜0.05）,与头孢唑肟治疗组比较,乳酸左氧氟沙星治疗组呕吐、腹痛、腹胀缓解时间缩短（P＜0.01）,开放饮食时间提前,住院天数、血象、CRP及血淀粉酶恢复正常时间均提前（P＜0.05）,影像学中胰腺炎症吸收快（P＜0.05）。结论 本研究表明：在急性水肿型胆源性胰腺炎抗感染治疗中,乳酸左氧氟沙星效果优于头孢唑肟。     

Diagnostic delay after dimenhydrinate use in vomiting children.

OBJECTIVE: To determine whether the use of dimenhydrinate was associated with delay in the diagnosis and management of treatable illnesses or with direct adverse effects in children with vomiting presenting to an emergency department. DESIGN: Questionnaire survey and review of drug reaction and telephone inquiry records. SETTING: The emergency department of a tertiary care children's hospital and a provincial poison information centre. PATIENTS: The parents of 148 children who presented with vomiting completed the questionnaire. The database at the poison information centre included 474 reports of adverse drug reactions over an 8-year period and 105 reports of telephone inquiries over a 4-year period. MAIN RESULTS: Twenty-one (14%) of 148 children had received dimenhydrinate before arrival at the emergency department. The patients who had received dimenhydrinate were more likely than the others to present more than 12 hours after the onset of vomiting (14 [67%] of 21 v. 43 [34%] of 127, p less than 0.01). The discharge diagnoses for those who had received dimenhydrinate included asthma, pelvic inflammatory disease and urinary tract infection. No clinically important direct adverse reactions to dimenhydrinate were documented. CONCLUSIONS: The use of dimenhydrinate in children with vomiting is associated with a risk of delay in the diagnosis of treatable medical conditions.     

新型冠状病毒肺炎疫情下急症介入超声的诊疗

目的 探讨新型冠状病毒肺炎（COVID-19）疫情形势下我院急症介入超声工作的诊疗过程及体会,为疫情期间安全有效开展介入超声工作提供参考。方法 总结回顾COVID-19疫情期间我院超声诊疗科紧急实施的3例急症患者介入超声诊疗经过,重点分析疫情形势下急症介入超声工作中对COVID-19重型患者的排查、介入穿刺适应证的选择、介入超声围手术期的防护及术后管理。结果 经流行病学筛查,患者1曾与COVID-19确诊患者有近距离接触史,胸部CT提示两肺下叶弥漫间质性渗出,经医院专家组会诊为COVID-19疑似病例,入院诊断为“咽后间隙感染”,需迅速清除感染灶;患者2经查排除COVID-19,入院诊断为“结石嵌顿性胆囊炎急性发作”,需迅速引流胆汁,解除胆囊梗阻;患者3经查排除COVID-19,入院诊断为“急性心包填塞”,需迅速引流心包积液。3例患者均经严格COVID-19排查流程,明确介入穿刺指征,术中患者1采用三级防护措施,另外2例患者采用一级防护措施。3例重症患者介入超声治疗均一次性成功,术后患者临床症状明显改善,术中平均耗时较短,出血量极少。结论 介入超声有微创、便捷、高效等诸多优势,非常贴合COVID-19疫情下急诊救治的需求,可成为某些急诊手术的替代方案或为重型COVID-19确诊/疑似患者提供一定的安全窗口期。我们的诊疗实践对于COVID-19疫情期间介入超声工作的安全有效开展具有一定的参考价值。     

25例自身免疫性溶血性贫血患者的临床分析

目的：探讨因急性贫血至急诊就诊的自身免疫性贫血患者使用糖皮质激素和输血治疗的疗效。方法：选择2004年1月至2005年12月至我院急诊就诊的25例患者作为研究对象，观察患者在急诊治疗期的治疗过程和疗效。结果：选择大剂量糖皮质激素和输血治疗的患者具有较快的改善临床症状和提高血红蛋白水平的趋势。结论：（1）因急性贫血就诊的自身免疫性贫血患者应紧急输血治疗以迅速改善临床症状：（2）使用大剂量激素辅助输血治疗可减少输血量，并能改善临床症状和提高血红蛋白水平。     

Clinical otorhinolaryngological presentation of COVID-19 patients in Saudi Arabia: A multicenter study

Objectives:To assess the otorhinolaryngological (ORL) symptoms, including their prevalence, severity, and early presentations among coronavirus disease-19 (COVID-19) patients in the Saudi population.Methods:This was a multicentric, cross-sectional study carried out on severe acute respiratory syndrome coronavirus-2 positive patients at 3 COVID-19 centres; Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, ALKhobar, Qatif Central Hospital, AlQatif, and Ohud Hospital, Al Madinah Al Munawarah, Saudi Arabia. The validated survey consisted of sociodemographic data, general symptoms of COVID-19, and ORL manifestations.Results:A total of 1734 COVID-19 positive patients were included in the study (mean age: 37.7±11.6 years). Most of the cases were mild (51.8%), followed by moderate (45.6%), and severe (2.6%) cases. Approximately 33.7% were asymptomatic. Severity of symptoms was significantly associated with male gender (p=0.017), higher age-group (p=0.04), and smoking (p<0.001). The most common initial ORL presentations were sore throat (20.9%), anosmia (15.5%), hyposmia (10%), and loss of taste (11.4%). Overall, 79.5% showed ORL symptoms as the initial presenting symptoms for COVID-19, with anosmia and sore throat being the most common symptoms.Conclusion:This study confirmed the prevalence of ORL symptoms among COVID-19 patients in Saudi Arabia. Moreover, these symptoms could also be considered for early detection of COVID-19 as they might appear prior to other symptoms.     

Emergency department post-coital contraception in Northern Ireland

Background The granting of a licence to Levonelle as an emergency hormonal contraceptive in the Republic of Ireland may require accident and emergency (A&E) departments to formally provide such a service. This article outlines the experiences of a Northern Ireland A&E unit. Aims To examine the pattern of attendance of patients requesting emergency contraception at an A&E department and to assess if adequate standards of care are achieved. Method Retrospective case note review of 100 patients attending the A&E department requesting emergency contraception. Results Sixty-one per cent of requests for emergency contraception were outside normal pharmacy opening hours. Seventy-seven per cent of these patients were less than 26 years old. Most (63%) attended within 24 hours of unprotected sexual intercourse. Forty-three per cent of the patients studied had used no contraception prior to this request. Recording of menstrual details and sexual behaviour as part of the consultation was variable. Conclusions A&E departments receive requests for emergency hormonal contraception particularly from younger women (<25 years). A&E staff must have appropriate training and support to manage these consultations effectively.     

奥氮平联合托烷司琼、地塞米松预防高致吐风险药物化疗引起恶心、呕吐的疗效分析

目的 观察奥氮平联合托烷司琼、地塞米松预防高致吐风险药物化疗引起恶心、呕吐的临床疗效和不良反应。方法 采用含高致吐风险药物化疗的78例患者随机分为观察组(奥氮平联合托烷司琼、地塞米松)和对照组(托烷司琼联合地塞米松),观察各组化疗后恶心、呕吐等不良反应的发生情况。结果 观察组与对照组防治急性呕吐的有效率分别为87.5%和81.6%,观察组与对照组防治急性恶心的有效率分别为65.0%和57.9%,差异均无统计学意义(P>0.05);观察组与对照组防治迟发性呕吐的有效率分别是75.0%和52.6%,观察组与对照组防治迟发性恶心的有效率分别为32.5%和13.2%,差异均有统计学意义(P<0.05)。两组间不良反应发生率比较,差异无统计学意义(P>0.05)。结论 奥氮平联合托烷司琼、地塞米松预防高致吐风险药物化疗所致迟发性恶心、呕吐疗效显著,不良反应轻。     

Does chronic radiation enteritis pose a diagnostic challenge? A report of three cases

We present three cases of late radiation enteritis, all admitted through the accident and emergency unit and managed in the surgical department. All presented with acute symptoms. Two had abdominal pain, nausea, and vomiting and in these two cases, plain radiology and computed tomography scans demonstrated small bowel obstruction. Exploratory laparotomies confirmed chronic radiation damage to the small bowel. The affected areas were resected and anastomoses were performed. The postoperative course was uneventful. The other patient presented with bleeding per rectum and a colonoscopy with biopsy of the rectum confirmed proctitis and radiation enteritis. This patient was treated conservatively and responded well. The key factor needed for successful diagnosis and management of chronic radiation enteritis is a high index of suspicion leading to appropriate use of imaging.     

Survey of neuromuscular monitoring and assessment of postoperative residual neuromuscular block in a postoperative anaesthetic care unit

INTRODUCTIONThe use of neuromuscular blocking agents (NMBAs) is common during general anaesthesia. Neuromuscular monitoring with a peripheral nerve stimulator (PNS) is essential to prevent postoperative residual neuromuscular block (PRNB), defined as a train-of-four (TOF) ratio < 0.9. PRNB remains a common complication and may contribute to morbidity in the postoperative anaesthetic care unit (PACU).METHODSAn online survey was sent to anaesthesiologists in our department to assess their knowledge and clinical practices related to neuromuscular blockade. Next, a study was conducted on adult patients scheduled for elective surgery under general anaesthesia requiring NMBAs. Upon admission to the PACU, TOF monitoring was performed.RESULTSA large proportion of anaesthesiologists showed a lack of knowledge of neuromuscular blockade or non-adherence to the best clinical practices associated with it. The majority (98.7%) stated that they did not routinely use PNS monitoring. In the clinical study, TOF monitoring was only used in 17.9% of the 335 patients who were assessed. The prevalence of PRNB was 33.4% and was associated with the elderly (age ≥ 65 years), a higher dose of NMBA used, a shorter duration of surgery, and a shorter duration between the last dose of NMBA and measurement of PRNB in the PACU. The incidence of adverse symptoms in the PACU was observed to be higher in patients with PRNB.CONCLUSIONPRNB remains a clinically significant problem, but routine PNS monitoring is rare in our institution. This is compounded by inadequate knowledge and poor adherence to best clinical guidelines related to neuromuscular blockade.     

Sudden unexpected death in the emergency department: caring for the survivors.

OBJECTIVE: To determine whether emergency department staff met the needs of the next of kin and close friends ("survivors") of patients dying in an emergency department and to assess the effectiveness of a program to improve care of survivors. DESIGN: Mail survey before and after program implementation. SETTING: Emergency department of a tertiary care, adult teaching hospital. PARTICIPANTS: Two groups of survivors, identified through a review of emergency department records of deaths during two 6-month periods. In the first group, surveyed in 1987, before program implementation, 26 (53%) of 49 responded; in the second group, surveyed in 1990, after program implementation, 40 (70%) of 57 responded. INTERVENTIONS: A structured, multidisciplinary protocol for notifying next of kin of death and supporting the survivors was implemented. An educational program was provided to all emergency department staff. An information pamphlet was created and provided to survivors. MAIN OUTCOME MEASURES: Questionnaire responses regarding the adequacy and timeliness of information provided, the support and actions by emergency department staff and the survivors' desire to be present during resuscitation efforts. RESULTS: Comparison of responses before and after program implementation showed that adequate information was provided before notification of death in 32% and 83% of cases respectively (p < 0.001), lengthy delays in receiving medical information occurred in 60% and 15% of cases (p < 0.01), adequate medical information concerning the events of death was provided in 53% and 88% (p < 0.05), the presence of emergency department staff was sufficient in 40% and 79% (p < 0.01), survivors spent less than 2 hours in the emergency department in 50% and 81% (p < 0.05), and survivors expressed a desire to be present during resuscitation efforts in 95% and 11% of cases (p < 0.001). CONCLUSION: The grievous experience of learning that a loved one has suddenly and unexpectedly died in the emergency department can be alleviated somewhat by a structured, multidisciplinary approach combined with staff sensitization and education.     

Using a Multihospital Systems Framework to Evaluate and Establish Drug Use Policy

Purpose. In order to develop rational drug purchasing and use policy for a class of pharmaceuticals used in a consortium system of 14 university based hospitals, the antiemetic use patterns of inpatients receiving cancer chemotherapy were evaluated to assess the comparative effectiveness of granisetron, ondansetron, and conventional antiemetics. Patients and Methods. A prospective, observational study was conducted in 14 academic health centers linked under research and purchasing consortium arrangements from October to December 1994. The use of antiemetics was evaluated in hospitalized patients receiving cancer chemotherapy agents with a known propensity for causing, alone or in combination, varying degrees of nausea or vomiting. Clinical outcomes measured were the impact of chemotherapy administration on the functional status of patients, and the occurrence of post-treatment vomiting. Results. The most often prescribed cancer chemotherapy regimens consisted of cisplatin, paclitaxel, etoposide and cyclophosphamide, and the most often prescribed antiemetics were the 5-hydroxytryptamine subtype-3 antagonists (5-HT₃ antagonists, granisetron and ondansetron), dexamethasone and lorazepam. Of the 439 patients studied, 329 (75%) reported no episodes of emesis. Of the patients receiving highly emetogenic chemotherapy, those receiving 5-HT₃ antagonists experienced better overall outcomes (as measured by functional health status and the absence of vomiting) than patients receiving conventional (non-5-HT₃ antagonist) antiemetics. In contrast, patients receiving chemotherapy associated with moderate or low emetogenicity experienced similar outcomes, regardless of the antiemetic regimen selected. No statistical difference was seen between granisetron and ondansetron in achieving positive patient outcomes. Conclusion. The study results suggest that 5-HT₃ antagonists are associated with better clinical outcomes than other antiemetics in patients receiving highly emetogenic chemotherapy. Less costly conventional antiemetic therapy (or, in some cases, no antiemetic therapy) provide comparable outcomes in patients receiving chemotherapy associated with moderate or low emetogenic potential. Granisetron and ondansetron were found to be clinically comparable.     

Intravenous thrombolysis for acute ischemic stroke with extended time window

Background:Intravenous thrombolysis (IVT) is an effective way for treating acute ischemic stroke (AIS). However, its effects have not been established among AIS patients with unclear stroke symptoms or with stroke onset for >4.5 h.Methods:We searched PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials and Google Scholar databases for randomized controlled trials that compared IVT (IVT group) and placebo or usual care (control group [CG]) in AIS patients with disease onset for >4.5 h. The outcomes of interest included the favorable functional outcome (defined as modified Rankin Scale [mRS] scores 0–1) at 90 days, the functional independence (defined as mRS scores 0–2) at 90 days, proportion of patients with symptomatic intracerebral hemorrhage (sICH) and death at 90 days. We assessed the risk of bias using the Cochrane tool. Pre-specified subgroup analyses were performed by age (≤70 years or >70 years), National Institute of Health Stroke Scale (NIHSS, ≤10 or >10) and time window (4.5–9.0 h or >9.0 h).Results:Four trials involving 848 patients were eligible. The risk of bias of included trials was low. Patients in the IVT group were more likely to achieve favorable functional outcomes (45.8% vs. 36.7%; OR 1.48, 95% CI 1.12–1.96) and functional independence (63.8% vs. 55.7%; OR 1.43, 95% CI 1.08–1.90) at 90 days, but had higher risk of sICH (3.0% vs. 0.5%; OR 5.28, 95% CI 1.35–20.68) at 90 days than those in the CG. No significant difference in death at 90 days was found between the two groups (7.0% vs. 4.1%; OR 1.80; 95% CI 0.97–3.34).Conclusions:Use of IVT in patients with extended time window may improve their functional outcomes at 90 days, although IVT may induce increased risk of sICH. Care of these patients should well balance the potential benefits and harms of IVT.     

慢性阻塞性肺部疾病急性加重期患者的红细胞分布宽度与其30天预后的相关性

目的 探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者的红细胞分布宽度(RDW)的水平与其30天预后的相关性。 方法 选择2012年11月~2014年8月在上海市嘉定区中心医院急诊科就诊的499例已诊断为COPD并因急性发作入院的患者,根据临床转归分为存活组(n=463)和死亡组(n=36),比较两组患者的临床资料及其实验室指标的差异性。再根据RDW中位数水平分为RDW低值组(n=250)和RDW高值组(n=249),比较两组30天预后的差异,采用多元逐步回归分析预后不良的独立相关因素。 结果 死亡组患者的RDW水平[14.1(13.1~14.8) vs 15.0(13.2~16.2),P=0.005]显著高于存活组,同时年龄、白细胞计数及降钙素原亦显著增高(P<0.05)。RDW高值组的30天的病死率显著高于RDW低值组(10.0% vs 4.4%,P=0.016)。RDW水平(标准偏回归系数=0.116,P=0.015)、较差心功能(标准偏回归系数=0.23,P=0.000)及白细胞计数(标准偏回归系数=0.169,P=0.000)与AECOPD预后不良呈独立线性相关。 结论 RDW水平与 AECOPD患者的30天预后密切相关,对判断其预后有重要参考价值。     

Acute asthma: emergency department management and prospective evaluation of outcome.

To determine the current management of acute asthma in the emergency department and to evaluate outcome we reviewed the charts of 99 patients aged 15 to 55 years who presented to the emergency department of a tertiary referral, university-affiliated hospital and were subsequently discharged with a diagnosis of acute asthma. Outcome was evaluated prospectively, with a structured questionnaire, by telephone. During the visit pulsus paradoxus was documented in four patients. Spirometry was done in 63 patients; postbronchodilator values ranged from 0.9 to 4.1 L. A total of 92 patients received inhaled bronchodilator therapy, most by wet nebulization. Sixteen patients received anticholinergic agents and three received theophylline. Ingested corticosteroids were given to 27 patients. Of the 71 patients contacted, a mean of 12 days after the visit, 26 (37%) had sought further medical attention, 19 at the emergency department; 9 had required admission. Forty-six patients reported that their condition had improved, but over 60% continued to have cough, sputum production, nocturnal waking and early-morning chest tightness. The results indicate that asthma continues to be undertreated in the emergency department and highlight the importance of routine spirometry in all patients and the need for systemic corticosteroid therapy.     

Voiding dysfunction in children causes,management, and prognosis: A single-center retrospective study

Objectives:To review voiding dysfunction caused by 3 different etiologies; dysfunction voiding syndrome (DVS), neurogenic bladder secondary to spinal dysraphisim (NB), and valve bladder syndrome (VBS).Methods:A single-center retrospective study on children with voiding dysfunction followed up at King Abdulaziz University Hospital, Jeddah, Saudi Arabia from 2005 to 2017.Results:One hundred and ninety-nine children (67.3% boys) were included: Group 1 (n=75, DVS), Group 2 (n=64, NB), and Group 3 (n=60, VBS). Further classification according to the age at presentation; infants (46%), toddlers (27%) and school aged (28%). Management categories: 31% children needed observation only, 25% needed clean intermittent catheterization (CIC), 13% needed only surgery and 31% needed both surgery and CIC. Associated comorbidities: hydronephrosis (81%), vesicoureteral reflux (47%), pyelonephritis (37%) and renal scar (60%), all have negative impact on estimated glomerular filtration rate (eGFR). Urodynamic studies revealed poor bladder compliance in 57.6% and atonic bladder in 1.1%, progression to chronic kidney disease (22%), commenced on renal replacement therapy 11.5% and 4% died with ESKD. Overall improvement in the last eGFR is observed (p<0.001), but VBS group was the least to improve (p=0.021). There was a negative correlation between the last eGFR and age at presentation (p=0.002).Conclusion:Early diagnosis and management of childhood voiding dysfunction was associated with better prognosis. Children managed conservatively have better preservation of kidney function than those who needed surgery.     

首诊诊断未明行症状查因诊断的急诊患者临床分析

目的了解急诊患者中因首诊诊断未明确而采用症状查因诊断患者的症状类型及其住院率和病死率,探讨采用症状查因诊断对患者治疗和预后的影响。方法对17726例首诊诊断未明确而采用症状查因诊断的急诊患者的资料进行回顾性分析。结果(1)17726例采用症状查因诊断的患者占同期急诊患者的5·3%,占同期急诊留观和急诊抢救患者的17·5%。居前3位的症状分别是腹痛、发热和头痛。(2)17726例患者经急诊治疗痊愈出院16960例,需进一步住院治疗者693例,住院率为3·9%。需要住院患者中临床症状居前3位的分别是昏迷(26·7%)、抽搐(18·2%)、气促(16·0%)。经急诊抢救无效死亡73例,急诊病死率为0·4%,病死率居前3位的症状分别为昏迷(18·2%)、抽搐(0·92%)、胸痛(0·90%)。结论(1)在采用症状查因诊断的急诊患者中,腹痛查因、发热查因、头痛查因最常见。(2)采用症状查因诊断的患者出院率高于诊断明确者,但住院率和病死率与诊断明确者无差别。