急诊科非手术死亡原因：一项为期五年的单中心临床病理研究
Non-Surgical Causes of Death in the Emergency Department: A Five-Year Monocentric Clinicopathological Study.
摘要(中文译文)
非手术死亡发生在急诊科（ED）严重急性病理的背景下，且常在诊断时间有限和临床信息不完整的条件下发生。将死前临床评估与法医尸检结果相结合的数据仍然匮乏，尤其是在中欧和东欧地区。我们开展了一项回顾性、单中心描述性临床病理学研究，纳入2019年1月至2023年12月期间在一家三级护理医院急诊科连续发生的45例非手术死亡病例。对临床、生物学和时间数据进行回顾性分析，并与完整的法医尸检结果进行关联，以确定死亡原因并评估临床病理一致性。患者平均年龄为74.3岁，从急诊科入院至死亡的中位时间为142分钟。心血管疾病是该队列中最常见的死亡原因（35.6%），其次为脓毒症（22.2%）、非COVID呼吸道原因（15.6%）和SARS-CoV-2感染（17.8%）。37.8%的病例观察到完全临床病理一致，部分一致占多数（57.8%）。完全不一致较为罕见（4.4%）。尸检结果常显示多系统受累，尤其是在归因于脓毒症和COVID-19的死亡中。在这项基于尸检的描述性队列中，急诊科非手术死亡与疾病严重程度高和临床迅速恶化相关，限制了死前完整的病因学阐明。部分临床病理一致的高发生率可能反映了急诊环境中终末期病理生理机制的复杂性。通过尸检进行系统性临床病理关联对于理解特定的、快速致死的急诊科急性非手术死亡病例仍然至关重要。
Abstract
: Non-surgical deaths in the Emergency Department (ED) occur in the context of severe acute pathology and frequently under conditions of limited diagnostic time and incomplete clinical information. Data integrating ante-mortem clinical assessment with medico-legal autopsy results remain scarce, particularly in Central and Eastern Europe. : We conducted a retrospective, monocentric descriptive clinicopathological study including 45 consecutive non-surgical deaths occurring in the Emergency Department of a tertiary care hospital between January 2019 and December 2023. Clinical, biological, and temporal data were retrospectively analyzed and correlated with complete medico-legal autopsy findings in order to establish the cause of death and to assess clinicopathological concordance. The mean patient age was 74.3 years, and the median time from ED admission to death was 142 min. Cardiovascular disease was the most frequent cause of death in this cohort (35.6%), followed by sepsis (22.2%), non-COVID respiratory causes (15.6%), and SARS-CoV-2 infection (17.8%). Complete clinicopathological concordance was observed in 37.8% of cases, while partial concordance predominated (57.8%). Total discordance was rare (4.4%). Autopsy findings frequently demonstrated multisystem involvement, particularly in deaths attributed to sepsis and COVID-19. : In this descriptive, autopsy-based cohort, non-surgical deaths in the Emergency Department were associated with advanced disease severity and rapid clinical deterioration, limiting complete etiological clarification prior to death. The high rate of partial clinicopathological concordance may reflect the complexity of terminal pathophysiological mechanisms encountered in emergency settings. Systematic clinicopathological correlation through autopsy remains essential for understanding selected cases of acute non-surgical mortality in selected, rapidly fatal ED cases.
如何引用
AMA
Adrian-Iosif Moldoveanu, Diana Maria Orzata, Gabriel Veniamin Cozma, Radu Gheorghe Dan, Ovidiu Alexandru Mederle, Flavia Zara. Non-Surgical Causes of Death in the Emergency Department: A Five-Year Monocentric Clinicopathological Study.. Medicina (Kaunas, Lithuania). 2026; doi:10.3390/medicina62020293.
APA
Adrian-Iosif Moldoveanu, Diana Maria Orzata, Gabriel Veniamin Cozma, Radu Gheorghe Dan, Ovidiu Alexandru Mederle, Flavia Zara (2026). Non-Surgical Causes of Death in the Emergency Department: A Five-Year Monocentric Clinicopathological Study.. Medicina (Kaunas, Lithuania). https://doi.org/10.3390/medicina62020293
GB/T 7714
Adrian-Iosif Moldoveanu, Diana Maria Orzata, Gabriel Veniamin Cozma, Radu Gheorghe Dan, Ovidiu Alexandru Mederle, Flavia Zara. Non-Surgical Causes of Death in the Emergency Department: A Five-Year Monocentric Clinicopathological Study.[J]. Medicina (Kaunas, Lithuania), 2026 doi:10.3390/medicina62020293.
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