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Objective:Taking emergency department (ED) as a starting point, to analyze the epidemiological characteristics and mortality risk factors of sepsis, and to provide evidences for ED to carry out the strategy of "three early and two lower" for sepsis.Methods:Based on the ED and inpatient medical record management information platform of Tianjin Medical University Gernal Hospital, adult ED patients with sepsis from January 1, 2017 to December 31, 2020 were included according to the third international consensus definitions for sepsis and septic shock in 2016 and the consensus of Chinese experts on early prevention and blocking of sepsis in 2020. The epidemiological characteristics of patients were retrospectively analyzed. Chi-square test was used to compare the difference of age, sex, hospitalization times, length of stay, hospitalization cost and infection location between dead patients and survival patients, and a stepwise logistic regression model was used to analyze the influencing factors of mortality in hospitalized patients with ED sepsis.Results:A total of 7 494 patients with sepsis in ED were included in this study, and the annual and monthly component ratios varied from 3.8‰ to 6.1‰ and 2.0‰ to 9.0‰, respectively. The main characteristics of patients with sepsis in ED were as follows: 40-69 years old (46.0%), male (59.0%), mostly diagnosed with sepsis (96.8%), mainly treated with urban health insurance (59.6%), and ED diagnosis and treatment fees of 2 000-8 000 Yuan (51.1%). The mortality of hospitalized patients with ED sepsis was 24.4% and that of hospitalized patients with septic shock was 28.8%. The main characteristics of hospitalized patients with ED sepsis were as follows: most of them were male (56.2%) patients over 70 years old (56.0%), most of them were diagnosed with sepsis (94.0%) and hospitalized for the first time (76.0%), the median hospitalization time was 15 d, most of them were hospitalized under urban health insurance (65.2%), and the median hospitalization fees was 47 000 Yuan. The risk factors of death were influenced by age and length of stay. Patients aged 70 years or older had a higher risk of death than those aged from 18 to 39 years, and patients with a length of stay of more than 7 d had a lower risk of death than those with a length of stay of shorter than 7 d. The primary infection focus were mainly respiratory and urinary systems, while the death rate of patients with hematological and abdominal infections was relatively high, and the difference was statistically significant ( P<0.01). Respiratory and abdominal infections were risk factors for death in patients with ED sepsis. Conclusions:The composition ratio of sepsis in ED patients is not regular in time, so vigilance of sepsis in elderly men and patients with respiratory system, blood system, urinary system and abdominal infections should be constantly raised. Patients with sepsis who are older, hospitalized more frequently, hospitalized for a shorter time, and infected in the respiratory system or abdomen have a higher risk of death.
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Objective:To compare the ability of Vancouver chest pain rule, Triage Rule-out Using high-Sensitivity Troponin accelerated diagnostic protocol and Emergency Department Assessment of Chest pain Score accelerated diagnostic protocol in rapid assessment of patients with chest pain.Methods:Patients with chest pain suggestive of acute coronary syndrome were recruited from January 2017 to February 2017 in Emergency Department of Tianjin Medical University General Hospital. Patients were stratified into various risk groups with Vancouver chest pain rule, Triage Rule-out Using high-Sensitivity Troponin accelerated diagnostic protocol and Emergency Department Assessment of Chest pain Score accelerated diagnostic protocol. The end point was acute myocardial infarction (AMI) within 30 days.Results:A total of 134 patients were enrolled. Fifty-seven patients were preliminary classified as a low risk for suitable discharge by Triage Rule-out Using high-Sensitivity Troponin accelerated diagnostic protocol, and one of them had AMI within 30 days. The sensitivity of stratifying low-risk patient was 83.3%, the specificity was 43.8%, and the negative predictive value was 98.2%. Fifty-one patients were preliminary classified as a low risk for suitable discharge by Emergency Department Assessment of Chest pain Score accelerated diagnostic protocol, and none of them had AMI within 30 days; the sensitivity of stratifying low risk patient was 100%, the specificity was 39.8%, and the negative predictive value was 100%. Twenty-four patients were preliminary classified as a low risk for suitable discharge by Vancouver chest pain rule, and none of them had AMI within 30 days; the sensitivity of stratifying low risk patient was 100%, the specificity was 18.8%, and the negative predictive value was 100%.Conclusions:Using accelerated diagnostic protocols to stratify emergency department patients with chest pain achieved early and safe emergency department discharge. The Emergency Department Assessment of Chest pain Score accelerated diagnostic protocol stratified more than 30% of low-risk patient, with a sensitivity of no less than 98% and a specificity of no less than 99.5%.
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Objective To show epidemiological characteristics of adult emergency patients and to provide data support for grading clinics.Methods Adult emergency patients (older than 14 years) from 50 hospitals in Tianjin were included.Name,gender and age of patients,as well as visiting time/department,chief complaint,severity of the disease,prognosis were considered to cross-sectional survey from 8:00,30 Aug 2016 to8:00,31 Aug 2016.Chi-squared test,Fisher's exact test,or t test was used to statistical analysis as appropriate.Results Of 6 569 patients,most originated from medical (n =3 964,60.34％) and surgical (n =2 017,30.31％).Patients' average age was 46.90 ± 18.70 (14-99) years old and there were more patientsaged from 30 to 39 (n =1 285,19.56％).Hospital crowded periods were between 8:00-11:00 and 17:00-22:00.In these periods,average number of patients was more than 300.Concerning the severity of disease,83 patients (1.26％) were in grade 1 (the most severe cases),301 patients (4.58％) in grade 2,1 500 patients (22.83％) in grade 3,and 4 685 patients (71.33％) were in grade 4 (the less severe cases).Most ambulatory patient represented trauma (n =124,35.23％),neurological (n =68,19.32％) and cardiovascular (n =49,13.92％) diseases.However,50.57％ of them were not considered urgent.Conclusions Most patients visited emergency department were nonurgent and originated from medical and surgical department in Tianjin.Crowded periods gathered at 8:00-11:00 and 17:00-22:00.Most ambulatory patients were trauma,neurological and cardiovascular disease;however,half of them was stable and need no emergency intervention.
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Objective To observe the effects of hemoperfusion on homeostasis in patients with acute poisoning.Methods The data of 26 acute poisoning patients treated with hemoperfusion were retrospective analyzed.The clinical data included blood pH,PvCO2,PvO2,blood lactate,potassium,free-calcium,bicarbonate and blood glucose assayed and recorded at 0 min,30 min and 120 min after hemoperfusion.The statistical software SPSS 18.0 was utilized to analyze the statistical differences in the above biomarkers among three different intervals after hemoperfusion.Results At the beginning of hemoperfusion therapy,levels of homeostasis indicators were pH (7.36 ± 0.05),PvCO2 (41.0 ± 8.8) mmHg,PvO2 (37.0 ± 11.8)mmHg,lactate (1.35 ± 1.00) mmol/L,potassium (3.1 ± 0.5) mmol/L,sodium (136.3 ± 4.8)mmol/L,free-calcium (0.95 ± 0.11) mmol/L,blood glucose (7.90 ± 3.47) mmol/L,bicarbonate (22.8±3.3) mmol/L.At30min,the levels of those were (7.36±0.04),(40.0±5.7) mmHg,(41.0±7.5) mmHg,(1.11 ±0.57) mmol/L,(3.1±0.4) mmol/L,(137.3 ±5.4) mmol/L,(0.94 ±0.12) mmol/L,(6.20 ± 1.55) mmol/L,(22.2 ±2.3) mmol/L,respectively.At 120 min,the levels of those were (7.35 ± 0.06),(38.0 ± 6.7) mmHg,(46.0 ± 7.9) mmHg,(0.69 ± 0.52)mmol/L,(3.0±0.4) mmol/L,(137.3±5.0) mmol/L,(0.97±0.10) mmol/L,(5.88±1.43)mmol/L,(22.0± 2.2) mmol/L,respectively.Apparently,there were significant statistical difference in PvO2,lactate and blood glucose (P ＜ 0.05) among three different intervals,and no significant statistical differences in other indicators (P ＞ 0.05).Conclusions There were no significant effects of hemoperfusion on relevant indicators in acute poisoning patients.