Department of Pediatrics, Division of Quality and Safety, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
Acad Pediatr. 2011 Jul-Aug;11(4):333-41. doi: 10.1016/j.acap.2011.04.006.
Children with sickle cell disease (SCD) often receive care in the emergency department (ED), but the urgency of these frequent visits is not well understood. This study examined ED use by children with SCD by comparing the urgency of ED visits among children with SCD, asthma, and diabetes mellitus.
We conducted a retrospective cohort study of Maryland ED visits for SCD, diabetes, or asthma from 2000 to 2004. ED visits resulting in hospital admission were deemed urgent. The urgency of ED visits not resulting in admission was determined using 2 methodologies: evaluation and management (E/M) coding and resource utilization. Multivariable logistic regression models were used to compare the likelihood of admission or urgent, treat-and-release ED visits across the 3 chronic conditions.
Nearly half (45%) of ED visits with a primary diagnosis of SCD resulted in admission, which was substantially higher than the 12% seen for asthma (adjusted odds ratio [AOR] 6.9, 95% confidence interval [CI], 6.4-7.4) and comparable to that seen for diabetes (41%). ED visits associated with primary diagnoses of SCD (AOR 5.9, 95% CI, 5.3-6.5) and diabetes (AOR 6.6, 95% CI, 6.0-7.3) were more likely than those associated with asthma to result in either admission or a discharge of higher urgency, as measured by E/M coding. These relationships persisted among repeat ED visitors, for visits with any diagnosis (ie, primary or nonprimary) of SCD, diabetes, and asthma, and when evaluated using the resource utilization method.
Similar to visits by children with diabetes, ED visits by children with SCD are substantially more likely than those by children with asthma to be of high urgency.
镰状细胞病（SCD）患儿常在急诊科（ED）接受治疗，但这些频繁就诊的紧迫性尚不清楚。本研究通过比较 SCD、哮喘和糖尿病患儿 ED 就诊的紧迫性，来评估 SCD 患儿 ED 的使用情况。
我们对 2000 年至 2004 年马里兰州 ED 就诊的 SCD、糖尿病或哮喘患者进行了回顾性队列研究。因 ED 就诊而住院的患者被认为是紧急情况。对于未入院的 ED 就诊，使用两种方法确定就诊的紧迫性：评估和管理（E/M）编码和资源利用。多变量逻辑回归模型用于比较 3 种慢性病的入院或紧急、治疗后离院 ED 就诊的可能性。
近一半（45%）以 SCD 为主要诊断的 ED 就诊需要入院，这明显高于哮喘的 12%（校正比值比[OR] 6.9，95%置信区间[CI] 6.4-7.4），与糖尿病相当（41%）。以 SCD（OR 5.9，95% CI 5.3-6.5）和糖尿病（OR 6.6，95% CI 6.0-7.3）为主要诊断的 ED 就诊更有可能需要入院或出院，这是根据 E/M 编码确定的更紧急的出院方式。这些关系在重复 ED 就诊者中、在任何诊断（即主要诊断或非主要诊断）的 SCD、糖尿病和哮喘就诊中以及在使用资源利用方法评估时仍然存在。
与哮喘患儿就诊相比，SCD 患儿就诊更有可能需要紧急处理，这与糖尿病患儿就诊相似。
