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요양병원에서 전원 온 폐렴환자의 특성: 일개 권역응급의료센터의 후향적 연구

Characteristics of the pneumonia patients transferred from long-term care hospitals: retrospective study of one regional emergency medical center

대한응급의학회지 2020년 31권 2호 p.210 ~ 220
김호일 ( Kim Ho-Il ) - Chungnam National University Hospital Department of Emergency Medicine

 ( Ryu Seung ) - Chungnam National University Hospital Department of Emergency Medicine
정원준 ( Jeong Won-Joon ) - Chungnam National University Hospital Department of Emergency Medicine
조영철 ( Cho Yong-Chul ) - Chungnam National University Hospital Department of Emergency Medicine
안홍준 ( Ahn Hong-Joon ) - Chungnam National University Hospital Department of Emergency Medicine
조성욱 ( Cho Seong-Wook ) - Chungnam National University Hospital Department of Emergency Medicine
오세광 ( Oh Se-Kwang ) - Chungnam National University Hospital Department of Emergency Medicine
박정수 ( Park Jung-Soo ) - Chungnam National University Hospital Department of Emergency Medicine
유연호 ( You Yeon-Ho ) - Chungnam National University Hospital Department of Emergency Medicine

Abstract


Objective: This study investigated the characteristics of elderly pneumonia patients transferred from long-term care hospitals (LTCH).

Method: The initial emergency department (ED) data of patients, who were transferred from other hospitals and over 65 years old and hospitalized from 2014 to 2018 for pneumonia management through the ED, were extracted from the electronic medical records. The differences in the initial status and prognosis between the LTCH group and non-LTCH group were compared, and the initial ED variables that affect the in-hospital mortality of the LTCH group were investigated.

Results: The total number of patients was 1,032; 423 (41.0 %) were included in the LTCH group. Compared to the nonLTCH group, the following severity indices, some laboratory data, and mortality were worse in the LTCH group: systemic inflammatory reaction syndrome (SIRS) criteria ≥2 (65.0% vs. 56.7%, P=0.008), quick Sequential Organ Failure Assessment score ≥2 (48.2% vs. 20.4%, P<0.001), CURB-65 (Confusion, Urea nitrogen, Respiration rate, Blood pressure, Age≥65 years) criteria ≥3 (51.8% vs. 29.2%, P<0.001), pneumonia severity index (PSI) class ≥4 (86.5% vs. 61.2%, P<0.001), modified early warning score ≥5 (38.8% vs. 18.4%, P<0.001), serum albumin (median [IQR], 2.6 [2.2- 2.9] g/dL vs. 2.8 [2.4-3.2] g/dL; P<0.001), blood urea nitrogen/albumin (B/A) ratio (median [IQR], 8.0 [5.0-12.8] vs. 6.6 [4.4-10.4]; P<0.001), and in-hospital mortality (26.0% vs. 15.9%, P<0.001). Multivariate regression analysis revealed the albumin grade, B/A ratio grade, PSI class, and SIRS criteria to independently affect the in-hospital mortality of the LTCH group.

Conclusion: The LTCH group had poorer initial severity indices and higher in-hospital mortality than the non-LTCH group. In addition, the albumin grade, B/A ratio grade, could be used for the severity index of pneumonia patients transferred from the LTCH.

키워드

Pneumonia; Long-term care; Transfer; Prognosis
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