Background： Shock is a life-threatening condition in emergency departments （EDs） and is associated with a high mortality： however, its clinical characteristics and current interventions in China are seldom reporte...Background： Shock is a life-threatening condition in emergency departments （EDs） and is associated with a high mortality： however, its clinical characteristics and current interventions in China are seldom reported. This study investigated the clinical characteristics and current interventions of shock patients in Chinese EDs. Methods： This multicenter prospective cohort study was conducted in the EDs of 33 academic hospitals in 16 Chinese provinces. Adult shock patients were enrolled from December 2013 to April 2014. Age, sex, comorbidities, shock subtype, and vital signs were recorded on ED an＇ival; details of subsequent interventions and treatments were added. We compared those data between survivors and nonstu＇vivors. All patients were lbllowed tip for 3 days. The primary outcome was 3-day mortality. Binary logistic regression analysis identified the independent predictors of that mortality. Results： We enrolled 1095 shock patients. The 3-day mortality was 27.5%, 36.3%, and 29.0%, respectively, in the whole cohort and for cardiogenic and septic shock. Within the first 24 11, 1039 patients （94.9%） were admitted to the Intensive Care Unit. Use of bicarbonate, epinephrine, and dopamine is an independent predictor lbr mortality. Hemorrhage and trauma （39.1%）, along with sepsis （40.4%） were the most commonly observed causes of shock in the ED. In nondiabetic patients with cardiogenic shock, 3-day mortality was 69.2% for patients needing glucose control -- much higher than in those not needing glucose control （30.0%, P- 0.01 ）. Hydroxyethyl starch （HES） was applied in 29.6% of septic shock patients, and the mortality of septic patients who received HES was much higher than those who did not （38.2% vs. 25. 1%, P = 0.006）. Conclusions： In China, short-term mortality of shock patients in EDs is still high, especially among those with cardiogenic and septic shock. HES application needs to be restricted -- particularly in septic shock patients.展开更多
文摘Background： Shock is a life-threatening condition in emergency departments （EDs） and is associated with a high mortality： however, its clinical characteristics and current interventions in China are seldom reported. This study investigated the clinical characteristics and current interventions of shock patients in Chinese EDs. Methods： This multicenter prospective cohort study was conducted in the EDs of 33 academic hospitals in 16 Chinese provinces. Adult shock patients were enrolled from December 2013 to April 2014. Age, sex, comorbidities, shock subtype, and vital signs were recorded on ED an＇ival; details of subsequent interventions and treatments were added. We compared those data between survivors and nonstu＇vivors. All patients were lbllowed tip for 3 days. The primary outcome was 3-day mortality. Binary logistic regression analysis identified the independent predictors of that mortality. Results： We enrolled 1095 shock patients. The 3-day mortality was 27.5%, 36.3%, and 29.0%, respectively, in the whole cohort and for cardiogenic and septic shock. Within the first 24 11, 1039 patients （94.9%） were admitted to the Intensive Care Unit. Use of bicarbonate, epinephrine, and dopamine is an independent predictor lbr mortality. Hemorrhage and trauma （39.1%）, along with sepsis （40.4%） were the most commonly observed causes of shock in the ED. In nondiabetic patients with cardiogenic shock, 3-day mortality was 69.2% for patients needing glucose control -- much higher than in those not needing glucose control （30.0%, P- 0.01 ）. Hydroxyethyl starch （HES） was applied in 29.6% of septic shock patients, and the mortality of septic patients who received HES was much higher than those who did not （38.2% vs. 25. 1%, P = 0.006）. Conclusions： In China, short-term mortality of shock patients in EDs is still high, especially among those with cardiogenic and septic shock. HES application needs to be restricted -- particularly in septic shock patients.
