摘要目的 急诊科拥挤度测量方法是当前急诊科拥挤研究的瓶颈.本研究通过急诊科拥挤度主观评分(视觉模拟评分法,VAS)与国家急诊科拥挤度评分(NEDOCS)进行相关分析和一致性验证,旨在初步构建中国急诊科拥挤度评估系统.方法 对一家年急诊患者流量11万、2 000张住院病床的临床教学医院急诊科进行为期6个月的研究,研究期间每隔8 h (1:00,9:00,17:00)采集急诊科拥挤度评估数据,对拥挤度测量方法进行相关分析和Bland-Altman法进行一致性检验.结果 视觉模拟评分法(VAS)中,医师VAS (VAS-p)值显著低于护士VAS (VAS-n)值[(6.49±1.82) vs.(7.12±1.78),P＜0.01];信度检验(Kappa检验)显示,Kappa值为0.112 (P＜0.01),提示两者一致性强度微弱.医师和护士VAS均数(VAS-m)与NEDOCS具有显著相关性(r =0.714,P＜0.01),但Bland-Altman法一致性检验结果显示,95％的一致性界限为-32.47至71.42,其范围明显超过40分(一个拥挤度评分等级),提示两种方法的一致性差.结论 视觉模拟评分法存在明显不足,医师与护士VAS评分一致性差;VAS与NEDOCS两种测量方法间一致性也不理想,提示NEDOCS评分值与急诊工作人员对急诊科拥挤问题的主观感受并不一致,有必要对NEDOCS评估模型进行修订.

abstractsObjective To establish a practicable and easily mastered emergency department overcrowding (EDO) assessment system suitable for domestic ED setting by determining the validity and usefulness of the national emergency department over-crowding study (NEDOCS) tool in a 2000-bed tertiary care academic institution in China in comparison with visual analogue scale (VAS) in order to address the worldwide grave concern of EDO.Methods In a period of 6 months,data of subjective and objective EDO assessed simultaneously three times a day (1:00,9:00,17:00) were collected.The data were analyzed by using Bland-altmann method and Kappa test to determine the coincidence between VAS and NEDOCS assessments.Results The VAS-p value evaluated by physicians was significantly lower than VAS-n value evaluated by nurses [(6.49 ± 1.82) vs.(7.12 ± 1.78),P ＜ 0.01].The reliability analysis showed that Kappa value was as low as 0.112 (P ＜0.01) suggesting there was a great discrepancy between VAS-p value and VAS-n value.VAS-m (average value of VAS-p and VAS-n) was taken for comparing different evaluation systems.The significant correlation was found between the VAS-m and NEDOCS (r =0.7l4,P ＜0.01).However,the Bland-Altman plot showed the 95％ limit of coincidence was in an extensive range (-32.47 to 71.42) suggesting discrepancy existed between two methods.Conclusions The present study suggested there was a significant discrepancy between the two subjective assessments of ED crowding (VAS-p vs.VAS-n).There might be a fatal flaw existed in the assumptions of the original VAS method for EDO measurement.Using the Bland-Altman plot analysis,the results showed that NEDOCS did not authentically reflect the staff' s sense of overcrowding in the ED.It is very important and urgent to establish an objective and effective EDO evaluation system for ED management.