Mistry Rakesh D, Cho Christine S, Bilker Warren B, Brousseau David C, Alessandrini Evaline A
Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Acad Emerg Med. 2006 Dec;13(12):1304-11. doi: 10.1197/j.aem.2006.07.028. Epub 2006 Nov 10.
The lack of valid classification methods for emergency department (ED) visit urgency has resulted in large variation in reported rates of nonurgent ED utilization.
To compare four methods of defining ED visit urgency with the criterion standard, implicit criteria, for infant ED visits.
This was a secondary data analysis of a prospective birth cohort of Medicaid-enrolled infants who made at least one ED visit in the first six months of life. Complete ED visit data were reviewed to assess urgency via implicit criteria. The explicit criteria (adherence to prespecified criteria via complete ED charts), ED triage, diagnosis, and resources methods were also used to categorize visit urgency. Concordance and agreement (kappa) between the implicit criteria and alternative methods were measured.
A total of 1,213 ED visits were assessed. Mean age was 2.8 (SD +/- 1.78) months, and the most common diagnosis was upper respiratory infection (21.0%). Using implicit criteria, 52.3% of ED visits were deemed urgent. Urgent visits using other methods were as follows: explicit criteria, 51.8%; ED triage, 60.6%; diagnosis, 70.3%; and resources, 52.7%. Explicit criteria had the highest concordance (78.3%) and agreement (kappa = 0.57) with implicit criteria. Of limited data methods, resources demonstrated the best concordance (78.1%) and agreement (kappa = 0.56), while ED triage (67.9%) and diagnosis (71.6%) exhibited lower concordance and agreement (kappa = 0.35 and kappa = 0.42, respectively). Explicit criteria and resources equally misclassified urgency for 11.1% of visits; ED triage and diagnosis tended to overclassify visits as urgent.
The explicit criteria and resources methods best approximate implicit criteria in classifying ED visit urgency in infants younger than six months of age. If confirmed in further studies, resources utilized has the potential to be an inexpensive, easily applicable method for urgency classification of infant ED visits when limited data are available.
急诊科就诊紧急程度缺乏有效的分类方法，导致非紧急急诊科利用率的报告率差异很大。
将四种定义急诊科就诊紧急程度的方法与婴儿急诊科就诊的标准标准（隐含标准）进行比较。
这是一项对参加医疗补助计划的婴儿前瞻性出生队列的二次数据分析，这些婴儿在生命的前六个月至少有一次急诊科就诊。审查完整的急诊科就诊数据，通过隐含标准评估紧急程度。还使用明确标准（通过完整的急诊科病历符合预先指定的标准）、急诊科分诊、诊断和资源方法对就诊紧急程度进行分类。测量隐含标准与替代方法之间的一致性和一致性（kappa）。
共评估了1213次急诊科就诊。平均年龄为2.8（标准差±1.78）个月，最常见的诊断是上呼吸道感染（21.0%）。使用隐含标准，52.3%的急诊科就诊被视为紧急。使用其他方法的紧急就诊情况如下：明确标准，51.8%；急诊科分诊，60.6%；诊断，70.3%；资源，52.7%。明确标准与隐含标准的一致性最高（78.3%），一致性（kappa = 0.57）。在有限的数据方法中，资源显示出最佳的一致性（78.1%）和一致性（kappa = 0.56），而急诊科分诊（67.9%）和诊断（71.6%）的一致性和一致性较低（kappa分别为0.35和0.42）。明确标准和资源对11.1%的就诊紧急程度分类错误相同；急诊科分诊和诊断倾向于将就诊过度分类为紧急。
在对六个月以下婴儿的急诊科就诊紧急程度进行分类时，明确标准和资源方法最接近隐含标准。如果在进一步研究中得到证实，当数据有限时，所使用的资源有可能成为一种廉价、易于应用的婴儿急诊科就诊紧急程度分类方法。
