急診病患24小時內非計畫性轉入加護病房之存活分析

Survival Analysis for Unplanned Transfer to Intensive Care among Emergency Department Patients within 24 Hours of Admission

非計畫性轉入加護病房的病患，不僅有較高的死亡率，且會耗用較多的醫療資源，但至今少有相關的研究，足以提供加護病房預測此類病患死亡之參考依據。本研究透過Cox比例危險模式，針對急診24小時內非計畫性轉入加護病房的病患進行存活分析；以台北市某區域醫院於2008年1月初至2013年12月底共六年之中，由其急診24小時內非計畫性轉入其綜合加護病房之1,462位病患為樣本，資料為病患之診斷因子與人口變數。在整體樣本中，以男性的老年患者為大多數，而死亡病患群的年齡則高於存活病患組，並具有統計顯著。另外，關聯非外傷性腦受傷病患死亡風險的顯著因子為APACHEII分數，而影響腦外傷病患死亡風險的顯著因子則為Glasgow昏迷指數(GCS)與性別，且女性腦外傷患者的死亡風險是為男性的1.75倍。

Unplanned transfers to intensive care units (ICUs) not only have higher mortality rates, but also consume more medical resources, yet few publications could be found which report survival forecasts for unplanned transfers to ICUs. This study adopts the Cox proportional hazards model to investigate patient survival after unplanned transfer to intensive care from the emergency department within 24 hours of admission. The sampling period was for 6 years, from January 2008 to December 2013, and demographic and clinical variables were collected from 1,462 unplanned transfers to the comprehensive ICU of a regional hospital in Taipei, which occurred within 24 hours after emergency admission. Males and the elderly comprise the majority of the sampling data, which show that the post-ICU death group has a higher average age than that of the surviving group. Our research results indicate that the only risk factors with statistical significance are the APACHE II score for patients without head injuries and also both the gender and Glasgow Coma Scale (GCS) for the unplanned transfers who are suffering from traumatic brain injury, where females have 1.75 times the risk of their male counterparts.