Study On The Pre-hospital Time,Referral Time In Patients With Acute Aortic Dissection

Objective:1.To develop a questionnaire for pre-hospital time and referral time of patients with acute aortic dissection and to test its reliability and validity.2.To analyzsis the current status of pre-hospital time and referral time and their influencing factors in patients with acute aortic dissection.3.To propose targeted measures in order to shorten the pre-hospital time and referral time of patients with acute aortic dissection.Method:Literature review,Delphi method and other methods were used to form survey tools,and their reliability and validity were tested through pre-survey.A total of 173 patients with acute aortic dissection from the department of cardiac macrovascular surgery in a hospital in wuhan were conveniently selected.The questionnaire of pre-hospital and referral of patients with acute aortic dissection was conducted.Some research team members hand out and take back the questionnaire in person.The results of the study were recorded by Excel 2016.SPSS 19.0 was used for statistical analysis.Descriptive statistical methods,mann-whitney U test and kruskal-wallis H test were used for univariate analysis.Multiline linear regression and stepwise regression(? in =0.05,? out =0.1)were used for multivariate analysis.Result:1.The pre-hospital time and referral time questionnaire for patients with acute aortic dissection developed in this study had a retest reliability of 0.943 and a content validity index of 0.930.2.Among the 173 patients with acute aortic dissection,164 patients were referred,with a referral rate of 94.80%.3.The median decision time,transport time,and prehospital time of 173 patients with acute aortic dissection in this study were 25 minutes,30 minutes,and 70 minutes,respectively.The median referral time for 164 referral patients was 569 minutes.4.Multivariate linear regression analysis showed that the effect of 173 patients with acute aortic dissection of pre-hospital time factor for general information: cultural level,income,disease related factors: dyspnea,whether for persistent pain,pre-hospital related factors: the onset time,the reaction of the bystanders,perceived severity,attributed to other diseases,trying to rest and relaxation(P < 0.05).Factors affecting transit time were general information: residence,time to the nearest medical institution in residence,and pre-hospital related factors: perceived severity(P <0.05).The factors influencing pre-hospital time were general information: education level,time the nearest medical institution in the residence,disease-related factors: whether it was persistent pain,pre-hospital related factors: reaction of bystanders,perceived severity,mode of admission,attributed to other diseases(P <0.05).5.Multivariate linear regression analysis showed that the influence factors of 164 referral patients with acute aortic dissection,whose referral time for general information: age,disease related factors: the waist or abdomen pain,pain degree,referral related factors: the first clinical hospital,whether patients have been confirmed before referral,referral method,method of eventually cure department,referral hospital numbers,referral distance.(P < 0.05).Conclusion:1.The questionnaire for pre-hospital and referral of patients with acute aortic dissection developed in this study has a high reliability and validity,which can be used for formal investigation.2.The referral rate of patients with acute aortic dissection was relatively high.3.Decision time: the higher the education level,the higher the monthly income,the more serious the self-conscious symptoms,the shorter the decision time;Patients with dyspnea,persistent pain,and onset time between 8:00 and 18:00,the decision time for bystander reaction to seek medical treatment is shorter;After the onset attributed to other diseases,as far as possible rest and relaxation of patients,the decision time was longer.4.Transfer time: the shorter the time it takes for the patient to arrive at the nearest medical institution in the residence,the more severe the self-conscious symptoms and the shorter the transfer time;Patients living in cities had shorter transfert times.5.Pre-hospital time: the higher the education level of the patient,the shorter the time to arrive at the nearest medical institution in the residence,the more serious the self-conscious symptoms,and the shorter the pre-hospital time;Patients with persistent pain and bystander reaction at the onset of the disease were treated with medical measures and 120 patients were hospitalized,and their pre-hospital time was relatively short.In adition,prehospital time was longer after onset due to other illnesses.6.Referral time: the higher the degree of pain,the fewer the number of hospitals treated,the closer the referral distance,and the shorter the referral time;After arriving at the hospital of final care,patients who were admitted to the emergency department or the department directly had shorter referral time.Patients aged 70 years older or abdominal pain,whose first diagnosis was in a non-tertiary hospital,who were not diagnosed before referral,and whose referral time was longer if they were referred to 120 hospitals for final treatment.