本文由小咖机器人翻译整理

期刊来源：Ann Intern Med

原文链接：https://doi.org/10.7326/M23-2442

摘要内容如下：

背景

低风险急性肺栓塞（PE）患者的门诊治疗已被证明是安全有效的，但最近的证据表明，患者仍需住院治疗。很少有研究评估美国急诊科（EDS）急性PE出院率的当代现实世界趋势。

客观

评估2012年至2020年间急性PE的ED出院比例是否发生变化，以及哪些基线特征与ED出院相关。

设计

连续横断面分析。

设置

参与全国医院流动医疗护理调查的美国EDS。

病人

2012年至2020年间因急性肺栓塞急诊就诊的患者。

测量

急性PE出院比例和ED出院相关因素的全国趋势。

结果

在2012年至2020年期间，约有1635300次急性PE就诊。总体而言，ED出院率在一段时间内保持不变，2012年至2014年期间为38.2%（95%CI，17.9%至64.0%），2018年至2020年期间为33.4%（CI，21.0%至49.0%）（调整后的风险比为每年1.01[CI，0.89至1.14]）。没有基线特征，包括已建立的危险分层评分，可预测ED出院的可能性增加；然而，教学医院的患者和有私人保险的患者更有可能在出院时接受口服抗凝治疗。根据肺栓塞严重程度指数（PESI）分级，仅35.9%（CI，23.9%至50.0%）的低危患者，根据简化PESI评分，仅33.1%（CI，21.6%至47.0%）的低危患者，根据血流动力学稳定性，仅34.8%（CI，23.3%至48.0%）的低危患者从急诊出院。

局限性

横断面调查设计和无法判定诊断。

结论

在全国范围内的代表性样本中，急诊急性肺栓塞的出院率在2012年至2020年间似乎保持不变。只有三分之一的低风险患者出院接受门诊治疗，出院率似乎已经稳定下来。在美国，低危急性肺栓塞的门诊治疗在很大程度上仍未得到充分利用。

主要资金来源

没有。

英文原文如下：

Abstracts

BACKGROUND  Outpatient management of select patients with low-risk acute pulmonary embolism (PE) has been proven to be safe and effective, yet recent evidence suggests that patients are still managed with hospitalization. Few studies have assessed contemporary real-world trends in discharge rates from U.S. emergency departments (EDs) for acute PE.

OBJECTIVE  To evaluate whether the proportion of discharges from EDs for acute PE changed between 2012 and 2020 and which baseline characteristics are associated with ED discharge.

DESIGN  Serial cross-sectional analysis.

SETTING  U.S. EDs participating in the National Hospital Ambulatory Medical Care Survey.

PATIENTS  Patients with ED visits for acute PE between 2012 and 2020.

MEASUREMENTS  National trends in the proportion of discharges for acute PE and factors associated with ED discharge.

RESULTS  Between 2012 and 2020, there were approximately 1 635 300 visits for acute PE. Overall, ED discharge rates remained constant over time, with rates of 38.2% (95% CI, 17.9% to 64.0%) between 2012 and 2014 and 33.4% (CI, 21.0% to 49.0%) between 2018 and 2020 (adjusted risk ratio, 1.01 per year [CI, 0.89 to 1.14]). No baseline characteristics, including established risk stratification scores, were predictive of an increased likelihood of ED discharge; however, patients at teaching hospitals and those with private insurance were more likely to receive oral anticoagulation at discharge. Only 35.9% (CI, 23.9% to 50.0%) of patients who were considered low-risk according to their Pulmonary Embolism Severity Index (PESI) class, 33.1% (CI, 21.6% to 47.0%) according to simplified PESI score, and 34.8% (CI, 23.3% to 48.0%) according to hemodynamic stability were discharged from the ED setting.

LIMITATIONS  Cross-sectional survey design and inability to adjudicate diagnoses.

CONCLUSION  In a representative nationwide sample, rates of discharge from the ED for acute PE appear to have remained constant between 2012 and 2020. Only one third of low-risk patients were discharged for outpatient management, and rates seem to have stabilized. Outpatient management of low-risk acute PE may still be largely underutilized in the United States.

PRIMARY FUNDING SOURCE  None.

-----------分割线---------

点击链接：https://www.mediecogroup.com/community/user/vip/categories/ ，成为医咖会员，获取12项专属权益。

现在购买可享受最大优惠（买一年送三个月，买两年送一年），2024年2月10日起将不再享有该优惠。