降阶梯临床思维方式对急诊胸痛患者诊断准确率的影响

Effect of clinical thinking mode of descending ladder on diagnostic accuracy of emergency chest pain patients

目的探讨急诊胸痛患者采用降阶梯临床思维方式进行诊断对准确率的影响。方法选取中山市古镇人民医院急诊科2020年10月至2021年3月救治的543例急性胸痛患者,根据诊疗方式不同分为研究组(275例)与常规组(268例)。研究组中,男175例,女100例,年龄(52.4±20.0)岁,进行降阶梯思维方式管理;常规组中,男156例,女112例,年龄(53.5±21.0)岁,按照传统急诊管理。比较两组患者的急诊停留时间、急诊科医疗花费、诊断准确率、病死率及满意度。结果常规组急诊停留时间为(106.7±18.6)min,急诊科医疗花费为(1244.8±37.9)元,研究组分别为(85.0±7.0)min、(1032.7±21.8)元,两组比较,差异均有统计学意义(t=17.900、79.670,均P<0.001)。研究组急诊胸痛诊断准确率高于常规组[98.91%(272/275)比95.52%(256/268),χ^(2)=4.603,P=0.032]。研究组患者病死率为0.73%(2/275),常规组为3.36%(9/268),两组比较,差异有统计学意义(χ^(2)=4.734,P=0.030)。从接诊分诊合理性、抢救处置及时性和检查转运必要性3个维度对两组满意度进行评价,研究组患者各维度的满意度评分均高于常规组[接诊分诊合理性:(4.2±0.5)分比(2.8±1.0)分,t=20.550,P<0.001;抢救处置及时性:(4.5±0.3)分比(2.5±1.1)分,t=28.740,P<0.001;检查转运必要性:(4.6±0.2)分比(3.2±0.8)分,t=27.810,P<0.001]。结论降阶梯临床思维方式可显著提高急诊胸痛患者的急诊效率,且准确性更高,节约费用,患者满意度更高。

Objective To investigate the effect of clinical thinking mode of descending ladder on the accuracy of emergency chest pain patients.Methods Five hundred and forty-three emergency chest pain patients treated at Emergency Department,Guzhen People's Hospital of Zhongshan City from October 2020 to March 2021 were selected,and were divided into a study group(275 cases)and a conventional group(268 cases)according to the treatment methods.There were 156 males and 112 females in the conventional group,with an age of(52.4±20.0).There were 175 males and 100 females in the study group,with an age of(53.5±21.0).The study group were managed by the thinking mode of descending ladder,and the conventional group took traditional emergency management.The times staying at emergency department,medical cost at emergence department,diagnostic accuracies,case fatality rates,and satisfaction were compared between the two groups.Results The time staying at emergency department and medical cost at emergence department were(106.7±18.6)min and(1244.8±37.9)yuan in the conventional group,and were(85.0±7.0)min and(1032.7±21.8)yuan in the study group(t=17.900 and 79.670,both P<0.001).The diagnostic accuracy of the emergency chest pain patients in the study group was higher than that in the conventional group[98.91%(272/275)vs.95.52%(256/268);χ^(2)=4.603,P=0.032].The case fatality rate was 0.73%(2/275)in the study group,and was 3.36%(9/268)in the control group(χ^(2)=4.734,P=0.030).The satisfaction scores of triage rationality,timeliness of rescue and treatment,and necessity of inspection and transport in the study group were higher than those in the control group[(4.2±0.5)vs.(2.8±1.0),t=20.550,P<0.001;(4.5±0.3)vs.(2.5±1.1),t=28.740,P<0.001;and(4.6±0.2)vs.(3.2±0.8),t=27.810,P<0.001].Conclusion The clinical thinking mode of descending ladder can significantly improve the emergency efficiency of patients with chest pain in emergency department,with a higher accuracy and higher patient satisfaction,and is cost saving.