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Determinants of hospitalization from psychiatric E.R. from S. Gerardo hospital in Monza: epidemiological cross-sectional study

Published online by Cambridge University Press:  11 October 2011

Emanuela Giampieri ,
Alessandra Ratti ,
Alessandra Beretta ,
Cinzia Mattavelli ,
Elena Ferrarini ,
Carlo Pruneri  and
Italo Carta
Emanuela Giampieri*
Affiliation:
Unità Operative di Psichiatria 36 e 37, Clinica Psichiatrica, Università degli Studi Milano Bicocca, Ospedale S. Gerardo di Monza, Monza
Alessandra Ratti
Affiliation:
Unità Operative di Psichiatria 36 e 37, Clinica Psichiatrica, Università degli Studi Milano Bicocca, Ospedale S. Gerardo di Monza, Monza
Alessandra Beretta
Affiliation:
Unità Operative di Psichiatria 36 e 37, Clinica Psichiatrica, Università degli Studi Milano Bicocca, Ospedale S. Gerardo di Monza, Monza
Cinzia Mattavelli
Affiliation:
Unità Operative di Psichiatria 36 e 37, Clinica Psichiatrica, Università degli Studi Milano Bicocca, Ospedale S. Gerardo di Monza, Monza
Elena Ferrarini
Affiliation:
Unità Operative di Psichiatria 36 e 37, Clinica Psichiatrica, Università degli Studi Milano Bicocca, Ospedale S. Gerardo di Monza, Monza
Carlo Pruneri
Affiliation:
Unità Operative di Psichiatria 36 e 37, Clinica Psichiatrica, Università degli Studi Milano Bicocca, Ospedale S. Gerardo di Monza, Monza
Italo Carta
Affiliation:
Unità Operative di Psichiatria 36 e 37, Clinica Psichiatrica, Università degli Studi Milano Bicocca, Ospedale S. Gerardo di Monza, Monza
*
Address for correspondence: Dr.ssa E. Giampieri, Clinica Psichiatrica, UOP 37, Università degli Studi di Milano Bicocca, Azienda Ospedaliera S.Gerardo di Monza, Via Donizetti 106, 20052 Monza, Milano. Fax: +39-039-233.2403 E-mail: [email protected], [email protected]
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Summary

Objective – The study aims to identify the predicting factors of hospitalization in patients who come in Emergency Room with psychiatric symptoms. Method – Cross-sectional study using data collected by E.R. of S.Gerardo Hospital in Monza from 1st of June 1995 to 31 May 1997. Inclusion criteria were age older than 18 and the need for psychiatric evaluation. The influence on disposition decision of demographic, clinical and service variables were assessed. Main outcome measures – Data were collected by a questionnaire designed for the study and administered by a trained psychiatrist. Statistical analysis was performed by univariate analysis and logistic regression. Results – 2076 cases were evaluated. Univariate analysis yielded higher odds of hospitalization for patients between 39 and 48 years of age, unmarried, unemployed, affected by schizophrenia, mood disorders or personality disorders. A linear trend was reported between hospitalization and severity of illness, siucide risk and aggressivness. While anxiety proved to be a protective factor, hallucination, delusion, lack of insight, psychomotor inhibition, agitation, confusion, destructive behaviour, odd behaviour, abnormal consciousness and previous hospitalization increase inpatient disposition. On Monday and Friday higher frequency of hospitalization was observed. Logistic regression confirm the role of age, symptoms, aggressive behaviour, severity of illness, suicide risk, and, among services variables, days of the week. Conclusion – Clinical variables proved to be the main predictors of hospitalization, and an important role is played by the availability of outpatients services: hospitalization was more frequent in the days closer the week-end, when the outpatient services are closed.

Riassunto

Scopo – Individuare i fattori predittivi di ricovero in pazienti che giungono presso il Pronto Soccorso con problem psichiatrici. Disegno – Studio epidemiologico trasversale condotto presso il Pronto Soccorso dell'Ospedale S. Gerardo di Monza, tra il 1 giugno 1995 ed il 31 maggio 1997. Sono stati inclusi tutti i soggetti di età maggiore di 18 anni per i quali sia stata richiesta una valutazione psichiatrica. E' stato sondato il peso di variabili socio-demografiche, di variabili cliniche e di variabili di servizio sulla decisione di ricovero. Principali misure utilizzate – I dati sono stati raccolti mediante una scheda appositamente costruita, compilata dal medico di guardia al momento della visita. I dati sono stati analizzati tramite analisi univariata e regressione logistica. Risultati – Sono stati raccolti dati inerenti 2076 casi. All'analisi univariata la probabilita di ricovero è risultata più elevata per soggetti tra i 39 ed i 48 anni, celibi o nubili, disoccupati, affetti da schizofrenia, da disturbi deH'umore o da disturbi di personalità. Il ricovero è più probabile in proporzione alia gravità, all'ideazione suicidiaria ed a precedenti ricoveri. Tra i sintomi troviamo che l'ansia protegge dal ricovero laddove allucinazioni, delirio, assenza di critica di malattia, blocco psicomotorio, agitazione psicomotoria, stato confusionale, crisi pantoclastiche, bizzarrie comportamentali, alterazioni dello stato di coscienza e precedenti ricoveri incrementano la probabilità di ospedalizzazione. Il lunedì ed il venerdì sono i giorni a più alta frequenza di ricoveri. La regressione logistica conferma il ruolo predittivo di età, sintomi, aggressività, gravità ed ideazione suicidiaria, e dei giorni della settimana tra le variabili di servizio. Conclusione – Tra i fattori predittivi di ricovero in SPDC le variabili cliniche mantengono un ruolo predominante, rispetto a fattori socio-demografici. Accanto a queste, tuttavia, si nota un peso rilevante deH'organizzazione del servizio con un aumento del tasso di ricoveri proprio nei giorni a cavallo del fine settimana, quando i servizi territoriali chiudono.

Keywords

fattori predittivi di ricoveroemergenze psichiatrichevariabili socio-demografichevariabili clinichevariabili di servizioPronto Soccorsoregressione logisticapredictor variables in hospitalizationpsychiatric emergenciesdemographicclinical and organizative characteristicsEmergency Roomlogistic regression
Type
Articles
Information
Epidemiology and Psychiatric Sciences , Volume 11 , Issue 4 , December 2002 , pp. 266 - 276
Copyright
Copyright © Cambridge University Press 2002

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