RESUMO
Objective To investigate the influence of meteorological factors on the number of patients and the time patients visiting the emergency department for medical care.Methods The data of meteorological variation and air pollution associated with the characteristics of distribution of time when the patients visited the emergency department in a tertiary grade A class hospital in Shanghai were collected in 2016.Quasi Poisson generalized additive model (GAM) applied for time series analysis was used to find the correlation between daily temperature and number of patients visiting emergency department,and with the distributed lag nonlinear model (DLNM) the relationship between the temperature and humidity was established and the confounding factors related with time visiting the emergency department was controlled in this model.Results In 2016,the average number of emergency visits in a tertiary grade A class hospital in Shanghai was 1027.The peak flow of patients occurred between 18:00 to-22:00 and trough emerged between 2:00 to-8:00.The number of visits in winter was greater than that in spring and autumn,and the number of patients on weekends and holidays was more than that on weekdays.The response of temperature exposure to the change of emergency volume in the hospital showed a J shape distribution.The low temperature and high temperature caused increase in visits,and the low temperature effect could last more than 2 weeks.The lowest number of visits occurred when the temperature (that is the lowest suitable temperature for medical treatment) was about 7 degrees Celsius,and the daily number of patients in emergency internal medicine was increased to 1.09 times (95％CI:1.03～1.16) compared with the optimum temperature.Compared with the optimum temperature,the daily visits increased to 1.27 times (95％CI:1.08～1.50) in the highest temperature.When the suitable temperature decreased by 1 degree,the visiting quantity increased by 2.43％ (95％CI:0.83％～4.18％),and the number of visits increased by 0.96％ (95％CI:0.31％～1.64％) every 1 degree rise.Conclusions There was a difference in the number of emergency visits between different times,and low temperature and high temperature had an obvious influence on the amount of emergency visits,and the effect of low temperature on the volume of visits was more lasting.
RESUMO
Objective To investigate the performance of Injury Severity Score (ISS), New Injury Severity Score (NISS), Revised Trauma Score (RTS), CRAMS (circulation, respiration, abdomen, motor, speech)score and combined score on the trauma response of trauma patients. Methods Data of acute trauma patients from March 2014 to February 2015 were chosen as the research object. The clinical information at admission was recorded, and the ISS, NISS, RTS, CRAMS and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) were calculated. The optimal cut-off values were looked for the comparability between the four scores and APACHE Ⅱ score were figured out by ROC curve. The joint diagnosis combined physiological score with anatomical score in overlap mode was used for comparing sensitivity and specificity. Results There was a total of 1 020 patients included in the study. APACHEⅡscore ≥20 was found 711 cases, and APACHEⅡ<20 was 309 patients, and there were significant statistic differences in ISS score (U=11.347, P<0.05),NISS score (U=11.969, P<0.05),CRAMS score (U=8.194, P < 0.05) and RTS score (U=8.357, P < 0.05) between two groups. It was showed by ROC curve analysis that the area under the ROC curve (AUC) of ISS, NISS, CRAMS and RTS was 0.907, 0.941, 0.768 and 0.803 (all P<0.05). Compared with the trauma score, combined scores could increase the sensitivity of the prompt assessment of trauma severity in trauma patients, but the combined scores may also reduce the specificity. Conclusions Of these four scoring systems, NISS has the best correlation with APACHEⅡ. Compared with the trauma score, combined scores can increase the sensitivity of the prompt assessment of trauma severity in trauma patients, but the combined scores may also reduce the specificity.