急诊腹痛患者急诊滞留时间影响因素的回顾性队列研究

Retrospective Cohort Study on Influencing Factors of Emergency Detention Time of Emergency Abdominal Pain Patients

摘要: 目的：探讨急诊腹痛患者急诊滞留时间(length of stay, LOS)的多维影响因素，为优化急诊流程、合理配置资源提供循证依据。方法：采用回顾性队列研究设计，提取2024年1月至2025年6月珠海市中西医结合医院急诊科91例腹痛患者的电子病历数据。收集患者特征、疾病严重度、诊疗流程及系统资源四个维度共31项变量。采用Cox比例风险回归模型分析LOS的独立影响因素。结果：本研究91例患者急诊LOS中位时间为295.00 (210.00, 425.00)分钟。多因素分析显示，急腹症标志阳性(aHR = 0.42, 95%CI 0.23~0.76)、影像检查次数多(aHR = 0.68, 95%CI 0.51~0.91)、检验项数多(aHR = 0.85, 95%CI 0.77~0.94)、夜班就诊(aHR = 0.54, 95%CI 0.31~0.95)及高分诊级别(≥Ⅲ级) (aHR = 0.61, 95%CI 0.38~0.98)是LOS延长的独立危险因素(均P < 0.05)，而镇痛药使用(aHR = 1.58, 95%CI 1.02~2.45)与LOS缩短相关。结论：急诊腹痛患者滞留时间受病情复杂性、诊断流程、系统资源等多因素影响。优化检查效率、推行夜间资源弹性调配、落实早期镇痛可能有助于缩短LOS。

Abstract: Objective: To explore the multi-dimensional influencing factors of the length of stay, LOS) of emergency patients with abdominal pain, and to provide evidence-based basis for optimizing emergency procedures and rationally allocating resources. Methods: Retrospective cohort study design was used to extract the electronic medical records of 91 patients with abdominal pain in the emergency department of Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine from January 2024 to June 2025. A total of 31 variables were collected from four dimensions: patient characteristics, disease severity, diagnosis and treatment process and system resources. Cox proportional hazard regression model was used to analyze the independent influencing factors of LOS. Results: The median time of emergency LOS of 91 patients in this study was 295.00 (210.00, 425.00) minutes. Multivariate analysis showed that the signs of acute abdomen were positive (aHR = 0.42, 95% CI 0.23~0.76), the number of imaging examinations was more (aHR = 0.68, 95% CI 0.51~0.91) and the number of examination items was more (aHR = 0.85, 95% CI 0.77~0.94). 95% CI 0.31~0.95) and high diagnostic grade (≥Ⅲ) (aHR = 0.61, 95% CI 0.38~0.98) are independent risk factors for the prolongation of LOS (all P < 0.05), while analgesic use (aHR = 1.58, 95% CI 1.02~2.45). Conclusion: The detention time of emergency patients with abdominal pain is influenced by many factors, such as the complexity of the disease, the diagnosis process and the system resources. Optimizing examination efficiency, implementing flexible allocation of resources at night and implementing early analgesia may help to shorten LOS.