Gibson Nicholas P, Jelinek George A, Jiwa Moyez, Lynch Ann-Maree
Discipline of Emergency Medicine and School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Nedlands, WA 6009, Australia.
J Paediatr Child Health. 2010 Dec;46(12):723-8. doi: 10.1111/j.1440-1754.2010.01829.x. Epub 2010 Sep 3.
To characterise the phenomena of paediatric frequent attenders (FAs) to emergency departments (EDs) in Perth.
A linked data population study of all children (<15 years) attending Perth hospital EDs between 1 July 2000 and 31 December 2006. FAs attending five or more times annually were assessed for demographic characteristics, mode of arrival, urgency, clinical conditions and disposition by frequency of attendance.
Over 6.5 years, 229, 883 children contributed to 378, 068 annualised chains of events (mean 1.5). Most children (98.2%) attended EDs less than five times a year. The more frequently children attended, the more likely they were to be male, younger, self-referred, have respiratory or infectious disorders, and to arrive by ambulance. Characteristics of those attending 0-4 (n= 371 171) and 5-9 (n= 6405) times per year were broadly similar, while those attending 10-19 times per year (n= 461) were more urgent, had a higher frequency of respiratory disease and higher admission rates (all P < 0.001). Those attending more than 20 times a year (n= 31) had serious chronic illness.
Frequent attenders of 5-9 times a year may be no sicker or more in need of hospital services than those who attend less frequently. The preponderance of respiratory and infectious disorders across all FA groups suggests these could be the focus of further research. We advocate a holistic approach to take into account parental expectations, and a systems approach to change ED attendance behaviour.
描述珀斯地区儿科急诊频繁就诊者的现象。
对2000年7月1日至2006年12月31日期间在珀斯医院急诊科就诊的所有15岁以下儿童进行关联数据人群研究。对每年就诊5次及以上的频繁就诊者，按就诊频率评估其人口统计学特征、就诊方式、紧急程度、临床状况及处置情况。
在6.5年期间，229,883名儿童参与了378,068次年度事件链（平均1.5次）。大多数儿童（98.2%）每年就诊次数少于5次。儿童就诊越频繁，越有可能为男性、年龄较小、自行就诊、患有呼吸系统或感染性疾病，且通过救护车就诊。每年就诊0 - 4次（n = 371,171）和5 - 9次（n = 6,405）的儿童特征大致相似，而每年就诊10 - 19次（n = 461）的儿童情况更紧急，呼吸系统疾病频率更高，住院率也更高（所有P < 0.001）。每年就诊超过20次（n = 31）的儿童患有严重慢性疾病。
每年就诊5 - 9次的频繁就诊者可能并不比就诊次数较少者病情更严重或更需要住院服务。所有频繁就诊者群体中呼吸系统和感染性疾病占主导，这表明这些可能是进一步研究的重点。我们提倡采用综合方法考虑家长期望，并采用系统方法改变急诊就诊行为。
