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Does medical disparity exist while treating severe mental illness patients with acute appendicitis in emergency departments? A real-world database study.
Hung, Shang-Kai; Kou, Hao-Wei; Wu, Kai-Hsiang; Chen, Shou-Yen; Li, Chih-Huang; Lee, Chao-Wei; Hung, Yu-Yung; Gao, Shi-Ying; Wu, Po-Han; Hsieh, Chiao-Hsuan; Chaou, Chung-Hsien.
Afiliação
  • Hung SK; Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan City, 333, Taiwan.
  • Kou HW; Department of Surgery, Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 333, Taiwan.
  • Wu KH; Department of Emergency Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi County, 613, Taiwan.
  • Chen SY; Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi County, 613, Taiwan.
  • Li CH; Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan City, 333, Taiwan.
  • Lee CW; Graduate Institute of Clinical Medical Sciences, Division of Medical Education, College of Medicine, Chang Gung University, Taoyuan City, 333, Taiwan.
  • Hung YY; Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan City, 333, Taiwan.
  • Gao SY; Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan City, 333, Taiwan.
  • Wu PH; Department of Surgery, Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 333, Taiwan.
  • Hsieh CH; Graduate Institute of Clinical Medical Sciences, Division of Medical Education, College of Medicine, Chang Gung University, Taoyuan City, 333, Taiwan.
  • Chaou CH; College of Medicine, Chang Gung University, Guishan, Taoyuan City, 333, Taiwan.
BMC Psychiatry ; 22(1): 488, 2022 07 21.
Article em En | MEDLINE | ID: mdl-35864481
BACKGROUND: Patients with severe mental illness (SMI) have a shorter life expectancy and have been considered by the World Health Organization (WHO) as a vulnerable group. As the causes for this mortality gap are complex, clarification regarding the contributing factors is crucial to improving the health care of SMI patients. Acute appendicitis is one of the most common indications for emergency surgery worldwide. A higher perforation rate has been found among psychiatric patients. This study aims to evaluate the differences in appendiceal perforation rate, emergency department (ED) management, in-hospital outcomes, and in-hospital expenditure among acute appendicitis patients with or without SMI via the use of a multi-centre database. METHODS: Relying on Chang Gung Research Database (CGRD) for data, we selectively used its data from January 1st, 2007 to December 31st, 2017. The diagnoses of acute appendicitis and SMI were confirmed by combining ICD codes with relevant medical records. A non-SMI patient group was matched at the ratio of 1:3 by using the Greedy algorithm. The outcomes were appendiceal perforation rate, ED treatment, in-hospital outcome, and in-hospital expenditure. RESULTS: A total of 25,766 patients from seven hospitals over a span of 11 years were recruited; among them, 11,513 were excluded by criteria, with 14,253 patients left for analysis. SMI group was older (50.5 vs. 44.4 years, p < 0.01) and had a higher percentage of females (56.5 vs. 44.4%, p = 0.01) and Charlson Comorbidity Index. An analysis of the matched group has revealed that the SMI group has a higher unscheduled 72-hour revisit to ED (17.9 vs. 10.4%, p = 0.01). There was no significant difference in appendiceal perforation rate, ED treatment, in-hospital outcome, and in-hospital expenditure. CONCLUSIONS: Our study demonstrated no obvious differences in appendiceal perforation rate, ED management, in-hospital outcomes, and in-hospital expenditure among SMI and non-SMI patients with acute appendicitis. A higher unscheduled 72-hour ED revisit rate prior to the diagnosis of acute appendicitis in the SMI group was found. ED health providers need to be cautious when it comes to SMI patients with vague symptoms or unspecified abdominal complaints.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Apendicite / Transtornos Mentais Tipo de estudo: Diagnostic_studies Limite: Female / Humans / Male Idioma: En Revista: BMC Psychiatry Assunto da revista: PSIQUIATRIA Ano de publicação: 2022 Tipo de documento: Article País de afiliação: Taiwan

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Apendicite / Transtornos Mentais Tipo de estudo: Diagnostic_studies Limite: Female / Humans / Male Idioma: En Revista: BMC Psychiatry Assunto da revista: PSIQUIATRIA Ano de publicação: 2022 Tipo de documento: Article País de afiliação: Taiwan