응급실 내원한 환자의 지역에 따른 사망위험 요인

Abstract

Background: There has been high demand in utilization of Emergency department since the Urbanization and Industrialization of the society have caused many different types of diseases and also aging of population and their eating habit have brought in many accurate diseases such as cardiovascular and cerebrovascular diseases which require emergent medical treatment. The number of utilization of Emergency department had reached to 1,044 million in 2017, which is 24 % higher than 838 million in 2007. Since the demands of more specialized and quality medical treatment in an emergency department has been requested. This study analyzed the outcomes of utilization of Emergency department, especially the differences of death rate from diseases with a high fatality rate such as acute myocardial infarction, stroke and pneumonia based on each different district. Methods: The study analyzed with 5,327,710 cases excluding unclear cases of emergent medical treatment based on National Emergency Department Information System collected from the first of July, 2016 to the 31st of December, 2017. This study used SAS program with frequency and percentage to find out the general characteristics of emergent patients. It also used χ2tests to identify whether or not there were any differences in the outcomes of utilization of an emergency department in each different district and used multiple logistic regression model with Odds ratio, OR and 95% Confidence Interval to find a correlation between the outcomes of emergent medical treatment and an emergency department in each different district. Results: This study shows that an emergent medical treatment which is conducted by an emergency department based on each different district affects the outcome of emergent medical treatment. This study categorized emergency departments into Capital, metropolitan cities, and the other regions to analyze the outcomes. The OR of the death rate occurred in emergency departments in metropolitan cities compared to Capital was 1.10(95% CI: 1.06-1.14), In the other regions, the OR was 1,31(95% CI: 1,27-1,36), which was meaningful The OR of the death rate of acute myocardial infarction with a high fatality rate occurred in emergency departments in metropolitan cities was 1.08 (95% CI: 0.81-1.43), the one in the other regions is 1.40 (95% CI: 1.07—1.84), which was the other regions meaningful. In the case of stroke, the OR of the death rate occurred in emergency departments in metropolitan cities was 2.98( 95% CI: 2. 35-3.77), the one in the other districts was 2.80( 95% CI: 2.22-3.54), which was meaningful. In the case of pneumonia, the OR of the death rate occurred in emergency departments in metropolitan cities was 2.00( 95% CI:1.67-2.40) and the one in the other districts was 2.13( 95%, CI :1.80-2.54), which was meaningful. Conclusions: This study shows that There had been a correlation between the death rate and the medical treatments in emergency departments based on each different districts ( Capital, metropolitan cities, and the other regions), Especially, There had been a huge difference in each death rate of acute myocardial infarction, stroke, pneumonia based on each different districts. The conclusion which can be drawn from this study is that the uneven Emergent medical service based on an emergency department in each different district affects the outcome of medical treatment. proceeding from what has been said above, it should be concluded that Establishing more systematized Emergency Medical Service System based on each district to reduce the number of preventable deaths and distribute the quality medical services which meet the medical severity over the country evenly. Medical severity has increased in number recently. Although numerous efforts to improve Emergency Medical Service System has been made by the government, The role of government is considered more responsibly to meet the demands of more effective EMS and narrow the gap of the quality of emergent service among the districts.