Gil Aparicio R, Trenchs Sainz de la Maza V, Muñoz-Santanach D, Cayuela Guerrero C, Luaces Cubells C
Hospital Universitari Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, España.
An Pediatr (Barc). 2010 Jul;73(1):19-24. doi: 10.1016/j.anpedi.2010.02.010. Epub 2010 Jun 16.
To evaluate the appropriateness of ambulance use as transport to Emergency Medical Services and to determine if ambulance use is associated with preferential attention and to illness severity.
All patients attended in a Paediatric Emergency Department during 2008 were included. Two groups were defined: Group 1, patients arriving by ambulance and Group 2, patients arriving by any other means of transport. In order to evaluate the appropriateness of ambulance use, a random sample of 300 patients from the Group 1 was selected; the "Paediatric Ambulance Need Evaluation tool" was applied to final diagnosis. To assess the preferential attention, the rate of patients with triage evaluation, time to triage and time to medical attention were compared. Finally, to determine differences in the severity of illness, patients with triage level < or =3 and patients needing complementary examinations and/or hospital admission were analysed.
A total of 80537 patients were included, of which 2.5% arrived by ambulance. Estimation of the prevalence of inappropriate transport use was 31 % (95 CI%: 26.2-35.8%). Their main diagnoses were: epileptic attack (23-24.7%), panic attack (12-12.9%) and fever (12-12.9%). It was observed that triage evaluation, time to triage and time to medical attention was shorter in Group 1. The proportion of children with triage level < or =3, needing complementary examinations and/or hospital admission was higher in-Group 1.
A high number of patients arriving by ambulance could have used another means of transport. However, the greater severity of a significant number of patients justifies the preferential attention given. Triage use in all patients arriving by ambulance would help in the detection of high priority cases and to improve the Emergency Department performance.
评估使用救护车转运至紧急医疗服务机构的合理性，并确定使用救护车是否与优先诊治及疾病严重程度相关。
纳入2008年期间在儿科急诊科就诊的所有患者。分为两组：第1组为乘坐救护车抵达的患者，第2组为通过其他任何交通方式抵达的患者。为评估使用救护车的合理性，从第1组中随机抽取300名患者；将“儿科救护车需求评估工具”应用于最终诊断。为评估优先诊治情况，比较了进行分诊评估的患者比例、分诊时间和获得医疗关注的时间。最后，为确定疾病严重程度的差异，分析了分诊级别≤3级的患者以及需要进行补充检查和/或住院治疗的患者。
共纳入80537名患者，其中2.5%乘坐救护车抵达。估计不适当转运的患病率为31%（95%置信区间：26.2 - 35.8%）。其主要诊断为：癫痫发作（23 - 24.7%）、惊恐发作（12 - 12.9%）和发热（12 - 12.9%）。观察到第1组的分诊评估、分诊时间和获得医疗关注的时间更短。第1组中分诊级别≤3级、需要进行补充检查和/或住院治疗的儿童比例更高。
许多乘坐救护车抵达的患者本可以使用其他交通方式。然而，相当一部分患者病情较重，这证明了给予优先诊治是合理的。对所有乘坐救护车抵达的患者进行分诊有助于发现高优先级病例并提高急诊科的工作效率。
