Cincinnati Children's Hospital Medical Center, Division of Emergency Medicine, 3333 Burnet Ave, ML 2008, Cincinnati, OH 45229, USA.
Pediatrics. 2010 Nov;126(5):917-24. doi: 10.1542/peds.2010-0364. Epub 2010 Oct 18.
The purpose of this study was to assess whether referral to a pediatric emergency department (PED) by a primary care provider was associated with greater severity of illness, as determined on the basis of clinical measures and increased resource utilization.
A retrospective study of data for 121 088 children who presented to a PED with abdominal pain, fever, or respiratory complaints during a 5-year period was performed. Demographic data, referral status, and proxy markers of illness severity were collected from the medical records and analyzed.
A total of 26.3% of all patients seen in the PED presented with these 3 complaint categories. With adjustment for age, gender, race, and insurance class, referred patients were significantly more likely to have high triage acuity designations, higher rates of very abnormal vital signs, and higher admission rates, compared with patients who were self-referred. Referred patients were more likely to undergo testing (laboratory or radiologic), to receive intravenous fluid therapy and pain medications, and to be assigned higher-severity discharge diagnoses, such as appendicitis, septic shock, or status asthmaticus.
Referral by a primary care provider to a PED was significantly and independently associated with greater severity of illness and resource utilization. Referral status should be considered in algorithms used to triage cases for evaluation in the PED.
本研究旨在评估初级保健提供者转介至儿科急诊部（PED）是否与疾病严重程度相关，这是基于临床指标和增加的资源利用来确定的。
对 5 年内因腹痛、发热或呼吸道疾病就诊于 PED 的 121088 名儿童的数据进行回顾性研究。从病历中收集人口统计学数据、转介情况和疾病严重程度的替代标志物，并进行分析。
在 PED 就诊的所有患者中，共有 26.3%出现了这 3 种主诉类别。在调整年龄、性别、种族和保险类型后，与自行就诊的患者相比，转诊患者更有可能被分诊为高 acuity 级别，出现更高比例的非常异常生命体征，以及更高的入院率。转诊患者更有可能接受检查（实验室或影像学检查），接受静脉补液和止痛药物治疗，并且被分配到更严重的出院诊断，如阑尾炎、感染性休克或哮喘持续状态。
初级保健提供者向 PED 的转介与疾病严重程度和资源利用显著相关。在用于对 PED 评估的病例分诊的算法中，应考虑转介状态。
