加拿大Alberta省急诊室的成人哮喘表现
2009/05/18
哮喘是一种分布广泛的疾病，其在成人中的发病率约7%～10%，在急诊室（ED），哮喘加重情况非常常见。Brian H. Rowe等人对加拿大Alberta省急诊室中成人哮喘患者的情况进行了流行病学的相关调查。他们通过Alberta省的非卧床护理分类系统和省级数据库取得了1999年4月～2005年3月的6年期间的急诊室哮喘患者数据。收集到关于人口统计学、急诊室就诊周期、后期于非急诊区就诊情况等数据。然后根据一些描述性的总结和直接的就诊数据进行统计资料分析。
调查收集了48,942名成人的105,813次急诊室就诊情况，人均就诊2.2次。大部分患者（66%）仅有1次因哮喘去急诊室就诊的经历。女性患者就诊率（66%）比男性患者高。同性别同年龄段组的数据标准化得到的就诊率变化为，从1999/2000年的9.7/1,000下降到2004/2005年的6.8/1,000。有社会福利和津贴的人群的急诊就诊率相较同年龄段的其他人群要高。如更仔细的按照天、周、每月的趋势观察，发现这组人群中有9.8%曾有入院治疗，6.4%曾在1周内有反复的急诊室就诊史。调查人群中有67.4%曾到正常门诊随访。到第1次随访的预计中位时间为19天（95%CI，18：21）。
在Alberta省的急诊室，哮喘是很常见的病例，Rowe的这项调查发现在过去的几年间，哮喘的就诊率明显降低，根据年龄、性别、社会地位以及早期随访不佳等因素不同，就诊率也有不同。由此，有针对性的干涉这些患者的情况将有助于减少因哮喘到Alberta省急诊室就诊的几率。
（于娜 中国医科大学附属第一医院呼吸科 110001 摘译）
（Chest January 2009 135:57-65; doi:10.1378/chest.07-3041）
Asthma Presentations by Adults to Emergency Departments in Alberta, CanadaA Large Population-Based Study
1.Brian H. Rowe, MD, FCCP,
2.Donald C. Voaklander, PhD,
3.Dongsu Wang, MSc,
4.Ambikaipakan Senthilselvan, PhD,
5.Terry P. Klassen, MD,
6.Thomas J. Marrie, MD and
7.Rhonda J. Rosychuk, PhD*
Abstract
Background:Asthma is a widespread disease with a prevalence of approximately 7 to 10% in adults. Exacerbations are common in the emergency department (ED) setting. The objective of this study was to describe the epidemiology of asthma presentations to EDs made by adults in the province of Alberta, Canada.
Methods:The Ambulatory Care Classification System of Alberta and provincial administrative databases were used to obtain all ED encounters for asthma during 6 fiscal years (April 1999 to March 2005). Information extracted included demographics, ED visit timing, and subsequent visits to non-ED settings. Data analysis included descriptive summaries and directly standardized visit rates.
Results:There were 105,813 ED visits for asthma made by 48,942 distinct adults, with an average of 2.2 visits per individual. Most patients (66%) had only one asthma-related ED visit. Female patients (61.2%) presented more commonly than male patients. The gender- and age-standardized visit rates declined from 9.7/1,000 in 1999/2000 to 6.8/1,000 in 2004/2005. The welfare and Aboriginal subsidy groups had larger age-specific ED visits rates than other populations. Important daily, weekly, and monthly trends were observed. Hospital admission occurred in 9.8% of the cases; 6.4% had a repeat ED visit within 7 days. Overall, 67.4% of individuals had yet to have a non-ED follow-up visit by 1 week. The estimated median time to the first follow-up visit was 19 days (95% confidence interval, 18 to 21).
Conclusions:Asthma is a common presenting problem in Alberta EDs, and further study of these trends is required to understand the factors associated with the variation in presentations. The important findings include an overall decrease in the rates of presentation over the study period, disparities based on age, gender, and socioeconomic/cultural status, and the low rate of early follow-up. Targeted interventions could be implemented to address specific groups and reduce asthma-related visits to Alberta EDs.
