救急搬送受入れ不可の危険因子の分析(Risk factors for nonacceptance of referrals from paramedics who request emergency transportation: an analysis of emergency transport data from the Kanagawa Prefecture): 神奈川県救急搬送データより

【目的】医療機関が消防機関からの救急患者受入れ照会を受諾できないこと（以下「受入れ不可」）の危険因子（とくに患者背景因子と照会先医療機関属性）を明らかにする。【対象】平成25，26年度神奈川県救急搬送実態調査のデータを用いた。「受入れ不可」を目的変数，「年齢」「性別」「平休日」「覚知時間帯」「傷病程度」「内外因」「背景因子」「病床数」を説明変数とし多変量解析を行った。さらに「救命救急センター指定」「一般/精神科病床の有無」で5群に分けて解析した。【結果】全体の受入れ不可率は20.6%であり（全照会数16,722回），「背景因子」のうち「精神疾患」「自殺企図」「薬物」「飲酒」「認知症」「複数科目にまたがるもの」が有意な独立危険因子であった。｢救命救急センター（一般/精神科病床併設）｣の受入れ不可率は10.0%で「背景因子」の影響はなかった。｢非救命救急センター（一般/精神科病床併設）｣の受入れ不可率は19.8%で，「精神疾患」のみが有意な独立危険因子であった。それに対し｢非救命救急センター（一般病床のみ）｣の受入れ不可率は23.7%で，より多くの「背景因子」（「精神疾患」「自殺企図」「薬物」「飲酒」「認知症」「複数科目にまたがるもの」）が有意な独立危険因子であった。【結語】救命救急センターまたは一般/精神科病床併設の医療機関では，患者背景因子の「受入れ不可」に対する影響は少ない。 Aims : To identify risk factors (particularly patient background factors and medical institution attributes) for nonacceptance at hospitals of emergency patients referred by paramedics. Methods : This study used data from the 2013 – 2014 Kanagawa Emergency Transport Fact–Finding Survey. Multivariate analysis used “nonacceptance” as the outcome variable, and age, sex, weekday/holiday, emergency request time, severity of injury, cause of illness, subjects’ background factors, and number of beds as explanatory variables. Furthermore, the effect of background factors was analyzed after classifying data into five subgroups based on whether the hospital was approved emergency medical center or had a general/psychiatry department. Result s : Nonacceptance occurred in 20.6% of all inquiries (a total of 16,722 inquiries), and patient background factors such as psychiatric problems, suicide attempt, drugs, alcohol, dementia, and multiple illness were significant risk factors. The rate of nonacceptance by the emergency medical center with general/psychiatry department group was 10.0%, and patients’ background factors did not affect this outcome in multivariate analysis. The rate of nonacceptance by the nonemergency medical center with general/psychiatry department group was 19.8%, and psychiatric problems was the only significant risk factor. On the other hand, the rate of nonacceptance by the nonemergency medical center with general wards only group was 23.7%, and more patients’ background factors (psychiatric problems, suicide attempt, drugs, alcohol, dementia, and multiple illness) were significant risk factors. Conclusion : Patient background factors have little effect on “nonacceptance” by hospitals that are approved emergency medical centers and hospitals with general/psychiatry departments.