Effective Use of the Hybrid Emergency Room System in the Treatment of Patients with Non-Traumatic Critical Care Diseases: a retrospective, observational study

Abstract

Background The hybrid emergency room (ER) system can provide resuscitation, computed tomography imaging, endovascular treatment, and emergency surgery, without moving the patient. Although several reports have demonstrated the effectiveness of hybrid ER for trauma conditions, none have demonstrated its usefulness for non-traumatic critical diseases. In this observational study, we aimed to determine the benefits of hyprid ER in the treatment of patients with non-traumatic conditions. Methods We retrospectively reviewed the clinical characteristics of patients with non-traumatic conditions treated in a hybrid ER from August 2017 to July 2022. Patients who underwent surgery, endoscopy, or interventional radiology (IR) in the hybrid ER were selected and pathophysiologically divided into a bleeding and non-bleeding group. The severity of illness, transfusion, and prognosis were compared among the groups using Fisher’s exact test. Multivariate logistic regression analysis was performed for confirming the relationship among prognosis, transfusion, and hemorrhagic conditions in patients who underwent endoscopy and IR. Results Among 726 patients with non-traumatic conditions treated in a hybrid ER system, 50 patients (6.9%) experienced cardiopulmonary arrest at or before admission to the hybrid ER, 301 (41.5%) were in shock, 126 (17.4%) received blood transfusions, 42 (5.8%) died within 24 h of admission to the hybrid ER, and 141 (19.4%) died in the hospital. Of the 726 patients, 39, 122, and 100 underwent surgery, endoscopy, and IR, respectively, in the hybrid ER. In the bleeding group, patients who underwent endoscopy and IR were more in shock and were administered significantly more blood transfusions than those who underwent surgery (endoscopy: p<0.0001 and IR: p=0.0005); however, no difference in prognosis was observed. Multivariate analysis in patients who underwent endoscopy showed a trend toward more in-hospital deaths in non-hemorrhagic conditions than in hemorrhagic conditions (odds ratio=3.833, 95% confidence interval: 0.884–16.621, p=0.073); however, no significant relationship with in-hospital death was observed for any of the adjusted variables. Conclusion Hybrid ER may be particularly effective for hemorrhagic conditions requiring endoscopic or IR hemostasis. The combination of diagnosis and treatment without patient transfer and appropriate transfusion strategies in a hybrid ER may improve outcomes in patients with non-traumatic diseases.