Oterino de la Fuente D, Martínez Martínez A, González Fouces I, Peiró S
Instituto de Investigación en Servicios de Salud.
An Esp Pediatr. 1999 Apr;50(4):373-8.
A tendency exists towards an increase in hospital admissions of children whereas evidence shows that some of the admissions could have been avoided or the length of stays reduced. The aim of this study was to identify the proportion of unnecessary pediatric stays and the motive behind them.
Three hundred eighty-eight hospital stays of 151 children between 6 months and 14 years of age which were discharged by the local pediatric hospital service have been reviewed. Patients and stays were selected at random. Admissions were stratified by age group and stays by episode length. The Pediatric Appropriateness Evaluation Protocol (PAEP) was used to evaluate the necessity of the hospital stay.
Of the admissions, 27.8% (42/151) were evaluated as unnecessary, as were 48.7% (189/388) of the hospital stays. Long stays (except for hospitalizations longer than 9 days), programmed admissions (93.5%), first admissions to a hospital (59.9%) and admissions evaluated as unnecessary (80.6%) were significantly associated with unnecessary stays. Hospital organization and doctors' style of practice accounted for 74.1% of the unnecessary stays and children familiar circumstances for 21.7%.
The high proportion of unnecessary stays and the motives, which explained them, justify the great concern about the criteria for the hospitalization of children and early discharge planning. To improve coordination among hospitals, central services, primary health care services and social services is probably required.
儿童住院人数有增加的趋势，而有证据表明部分住院情况本可避免或缩短住院时长。本研究旨在确定不必要的儿科住院比例及其背后的原因。
回顾了当地儿科医院服务机构收治的151名6个月至14岁儿童的388次住院情况。患者和住院情况均随机选取。入院情况按年龄组分层，住院时长按发作时长分层。采用儿科适宜性评估方案（PAEP）评估住院的必要性。
在这些入院病例中，27.8%（42/151）被评估为不必要，住院天数中48.7%（189/388）被评估为不必要。长时间住院（住院时间超过9天的情况除外）、计划性入院（93.5%）、首次入院（59.9%）以及被评估为不必要的入院（80.6%）与不必要的住院显著相关。医院组织和医生的执业方式导致的不必要住院占74.1%，儿童熟悉环境导致的占21.7%。
不必要住院的高比例及其背后的原因，表明对儿童住院标准和提前出院计划的高度关注是合理的。为改善医院、中央服务机构、初级卫生保健服务机构和社会服务机构之间的协调，可能需要采取相应措施。
