年龄对急诊患者等待时间的影响：连续2年219299例患者的回顾性分析

Effect of age on waiting time of emergency patients： a retrospective analysis of 219299 patients in consecutive 2 years

目的探讨年龄≥70岁是否为导致急诊患者等待时间延长的危险因素，了解该人群在急诊分级预检系统中能否得到优先处理。方法采用回顾性研究方法，收集2016年1月1日至2017年12月31日在中山大学附属第三医院急诊科就诊的所有成人患者的临床资料。所有患者先接受四级急诊预检分诊，根据急诊分级结果给予相应处理。应用医院信息系统（HIS）检索入选患者的相关数据，包括性别、年龄、急诊分级、急诊科室、门诊开放情况和就诊时间。根据前期以65岁为界分析提示其与患者等待时间关联性不大的结论，按照年龄是否超过70岁将患者分为≥70岁组和〈70岁组进一步分析；以患者分诊后挂号登记时间与急诊医生录入初步诊断时间的差值作为等待时间，根据目标等待时间（TWT）达标情况将患者分别达标组和未达标组。TWT定义：Ⅰ级急危患者为即刻，Ⅱ级急重患者为10 min，Ⅲ级急症患者为30 min，Ⅳ级亚急症患者为60 min、非急症患者为2~4 h。采用多因素Logistic回归分析评估年龄是否为导致急诊患者等待时间超过TWT的独立危险因素。结果共入选急诊成人患者272？989例，排除妇产科急诊患者、分诊资料记录不全者、未予诊治即自行离院者、急诊分诊为Ⅰ级者、等待时间异常者（等待时间超过全部样本平均等待时间的99%），最终共219？299例急诊患者资料纳入分析。男性102？218例，女性117？081例；平均年龄（35.86±15.81）岁，其中〈70岁208？082例（占94.9%），≥70岁11？217例（占5.1%）。在219？299例急诊患者中，有191？588例（87.4%）在TWT内就诊，其中70岁以上的患者有86.5%（9？70/1？217）在TWT内就诊。多因素Logistic回归分析显示，年龄70岁与超过TWT就诊呈独立相关〔校正优势比（OR）=1.106，95%可信区间（95%CI）=1.041~1.176，P=0.001〕；同时，在高峰时段于急诊就诊和急诊分级偏低也是导致患者等待时间超过TWT的危险因素。根据不同急诊科室的Logistic回归分析显示，在老年患者就诊最多的急诊内科，去除其他原因影响后，年龄≥70岁患者等待时间未达标的可能性较小（校正OR=1.203，95%CI=1.121~1.291，P〈0.001）。结论在急诊分级预检系统中，年龄≥70岁的老年人在TWT内就诊的可能性较〈70岁者更大，容易得到优先诊治。

ObjectiveTo evaluate whether patients aged over 70 years old is an independent predictor for prolonging the waiting time, and to know whether the population can be prioritized in the emergency grading system.MethodsA retrospective analysis was conducted. All the clinical data of adult visitors to the emergency department of the Third Affiliated Hospital of Sun Yat-sen University from January 1st in 2016 to December 31st in 2017 were collected. All the patients received four emergency first aid triages and treated according to the emergency classification results. The relevant data of selected patients were retrieved from the hospital information system （HIS） including gender, age, triage level, triage department, outpatient service and initial diagnosis time. According to the conclusion of pre-phase analysis that the patients over 65 years old was not associated with waiting time, all subjects were divided into ≥ 70 years old group and 〈 70 years old group for further analysis. The waiting time was defined as the difference in registration time and the initial diagnosis time, and the patients were divided into two groups according to whether it exceeded the target waiting time （TWT）. TWT was considered as follows according to each emergency triage level： level Ⅰ instantly, level Ⅱ 10 minutes, level Ⅲ 30 minutes, level Ⅳ 60 minutes （subacute patients） or 2-4 hours （non-urgent patients）. The multivariable Logistic regression analysis was conducted to determine whether the factor that aged over 70 years old was an independent predictor for prolonging waiting time over TWT.ResultsThere were 272？989 adult visits recorded totally, of which obstetrics and gynecology department visits, incomplete personnel information, invalid diagnosis （or no diagnosis）, triage levelⅠ, abnormal waiting time （the waiting time exceeded 99% of the average waiting time of all samples） records were excluded. Finally, 219？299 emergency patients were enrolled, with 102？218 male and 117081 female, which showed an average age of （35.86±15.81） years, 208 082 patients （94.9%） in 〈 70 years old group, and 11？217 （5.1%） in ≥ 70 years old group. Totally 191 588 patients （87.4%） were diagnosed within the TWT, and the number was 86.5% （970/1217） in the ≥ 70 years old group. Multivariate Logistic regression analysis indicated that age under 70 years old was independently associated with an exceeded TWT [adjusted odds ratio （OR） = 1.106, 95% confidence interval （95%CI） = 1.041-1.176, P = 0.001]. Meanwhile, visits during the peak period or low triage level was also a risk factor of exceeded TWT. According to the Logistic regression analysis of different departments and removing other factors, in the emergency internal medicine with the most elderly patients, the probability of exceeded TWT in ≥ 70 years old group was lessened （adjusted OR = 1.203, 95%CI = 1.121-1.291, P 〈 0.001）.ConclusionIn the emergency pre-grading system, the elderly aged （≥ 70 years old） was more likely to see a doctor in TWT than those under 70 years old, so they were easy to get priority treatment.