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首页> 外文期刊>Canadian Journal of Emergency Medicine >Management of Discharged Emergency Department Patients with a Primary Diagnosis of Hypertension: A Multicentre Study
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Management of Discharged Emergency Department Patients with a Primary Diagnosis of Hypertension: A Multicentre Study

机译：急诊出院的急诊患者的高血压管理：一项多中心研究

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IntroductionMany patients are seen in the emergency department (ED) for hypertension, and the numbers will likely increase in the future. Given limited evidence to guide the management of such patients, the practice of one’s peers provides a de facto standard.MethodsA survey was distributed to emergency physicians during academic rounds at three community and four tertiary EDs. The primary outcome measure was the proportion of participants who had a blood pressure (BP) threshold at which they would offer a new antihypertensive prescription to patients they were sending home from the ED. Secondary outcomes included patient- and provider-level factors associated with initiating an antihypertensive based on clinical vignettes of a 69-year-old man with two levels of hypertension (160/100 vs 200/110 mm Hg), as well as the recommended number of days after which to follow up with a primary care provider following ED discharge.ResultsAll 81 surveys were completed (100%). Half (51.9%; 95% CI 40.5-63.1) of participants indicated that they had a systolic BP threshold for initiating an antihypertensive, and 55.6% (95% CI 44.1-66.6) had a diastolic threshold: mean systolic threshold was 199 mm Hg (SD 19) while diastolic was 111 mm Hg (SD 8). A higher BP (OR 12.9; 95% CI 7.5-22.2) and more patient comorbidities (OR 3.0; 95% CI 2.1-4.3) were associated with offering an antihypertensive prescription, while physician years of practice, certification type, and hospital type were not. Participants recommended follow-up care within a median 7.0 and 3.0 days for the patient with lower and higher BP levels, respectively.ConclusionsHalf of surveyed emergency physicians report having a BP threshold to start an antihypertensive; BP levels and number of patient comorbidities were associated with a modification of the decision, while physician characteristics were not. Most physicians recommended follow-up care within seven days of ED discharge.
机译：简介在急诊科（ED）可以看到许多患者患有高血压，并且将来这个数字可能还会增加。在指导这些患者管理的证据有限的情况下，同伴的行为提供了事实上的标准。方法在学术回合中，在三个社区和四个三级急诊室向急诊医师分发了一项调查。主要结局指标是具有血压（BP）阈值的参与者所占的比例，在该阈值下，他们将向急诊科送回家的患者提供新的降压处方。次要结果包括与患者和提供者有关的因素，这些因素与根据69岁男性有两种高血压水平（160/100 vs 200/110 mm Hg）的临床晕厥开始降压相关，以及推荐的数字ED出院后与初级保健提供者进行随访的天数。结果完成了所有81个调查（100％）。一半（51.9％; 95％CI 40.5-63.1）的参与者表示他们具有开始降压的收缩压阈值，而55.6％（95％CI 44.1-66.6）的具有舒张压阈值：平均收缩压阈值为199 mm Hg （SD 19），而舒张压为111 mm Hg（SD 8）。较高的血压（OR 12.9; 95％CI 7.5-22.2）和更多的患者合并症（OR 3.0; 95％CI 2.1-4.3）与提供降压处方有关，而医师的执业年限，认证类型和医院类型则与不。参与者建议分别对BP水平较低和较高的患者分别在7.0和3.0天内进行后续护理。结论半数接受调查的急诊医师报告具有开始降压的BP阈值。血压水平和患者合并症的数量与决定的修改相关，而医师的特征与否无关。大多数医生建议在ED出院后7天内进行后续护理。

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