Brousseau David C, Mistry Rakesh D, Alessandrini Evaline A
Department of Pediatrics, Section of Emergency Medicine and the Children's Research Institute, Medical College of Wisconsin, Milwaukee, WI, USA.
Pediatr Emerg Care. 2006 Sep;22(9):635-9. doi: 10.1097/01.pec.0000230712.89269.84.
Between 20% and 80% of emergency department (ED) visits are nonurgent. This variability in estimates is partially due to the multiple classification methods used, none of which has undergone validity or reliability testing. Our objectives were to determine the methods thought to be most valid and to understand expert perceptions of nonurgent ED utilization.
A survey of the Pediatric Emergency Medicine (PEM) Special Interest Group at the 2005 Pediatric Academic Societies meeting was conducted. An education session with case-based discussion for categorizing ED visit urgency was presented. Six methods were reviewed: implicit criteria, explicit criteria, resource utilization, diagnoses, Current Procedural Terminology Codes, and nurse triage category. The primary outcome was the percentage of respondents ranking each method first or second best for categorizing urgency. Respondents also identified ED resources and presenting symptoms constituting an urgent visit.
Seventy-four percent of attendees completed the survey, most were Pediatric Emergency Medicine physicians. Implicit criteria were rated highest, with 65.1% ranking it first or second, followed by explicit criteria (53.8%). With limited data available, resource utilization ranked highest (68.6%), followed by nurse triage (61.2%). There was an agreement that certain presenting symptoms and resources were adequate for determining ED visit urgency; however, there was no agreement on whether x-rays, urinalyses, or fever in a child older than 3 months was sufficient to identify urgency.
Methods using complete medical record information are favored to determine ED visit urgency. Resource utilization and nurse triage are preferred when limited data are available. This survey will serve as the basis for endorsement of methodologically sound criteria for ED visit urgency.
急诊就诊中20%至80%为非紧急情况。估计值的这种差异部分归因于所使用的多种分类方法，其中没有一种经过有效性或可靠性测试。我们的目的是确定被认为最有效的方法，并了解专家对非紧急急诊利用情况的看法。
在2005年儿科学术协会会议上对儿科急诊医学（PEM）特别兴趣小组进行了一项调查。举办了一次基于病例讨论的教育会议，用于对急诊就诊紧急程度进行分类。审查了六种方法：隐含标准、明确标准、资源利用、诊断、现行程序术语编码和护士分诊类别。主要结果是将每种方法评为分类紧急程度最佳或次佳的受访者百分比。受访者还确定了构成紧急就诊的急诊资源和就诊症状。
74%的与会者完成了调查，大多数是儿科急诊医学医生。隐含标准评分最高，65.1%的人将其评为最佳或次佳，其次是明确标准（53.8%）。在可用数据有限的情况下，资源利用排名最高（68.6%），其次是护士分诊（61.2%）。对于某些就诊症状和资源足以确定急诊就诊紧急程度达成了共识；然而，对于3个月以上儿童的X光检查、尿液分析或发热是否足以确定紧急程度没有达成共识。
倾向于使用完整病历信息的方法来确定急诊就诊紧急程度。在可用数据有限时，首选资源利用和护士分诊。这项调查将作为认可急诊就诊紧急程度方法学上合理标准的基础。
