Shaw K N, Selbst S M, Gill F M
Emergency Department, Children's Hospital of Philadelphia, Pennsylvania 19104.
Ann Emerg Med. 1990 Jan;19(1):59-62. doi: 10.1016/s0196-0644(05)82144-4.
We conducted a six-month prospective study of the diagnoses and outcomes of 588 children who were denied care in our emergency department under a new primary-care case management health system for 100,000 indigent patients. The mean patient age was 4.7 years (39% were less than 2 years old). The most common presenting complaints were colds, earaches, rash, vomiting, and diarrhea. Nine percent of children presented for trauma, and 10% had fever of more than 38.2 C. Follow-up was available from the primary care physician for 388 children (66%). Of the 60% of patients who kept their arranged appointment, 42% received antibiotics, 3% were referred for further evaluation, and two children were hospitalized. Follow-up was available from the parents for 125 children (21%). No follow-up information of any kind was available for 111 children (19%), and no follow-up regarding the health of the child was available for 265 children (45%). This last group included 10% with a chief complaint of trauma and 6% with temperature of more than 39 C. Forty-nine percent of patients in this group were less than 2 years old.
我们针对在一项面向10万名贫困患者的新型初级保健病例管理卫生系统下，被我们急诊科拒绝治疗的588名儿童的诊断和结局开展了一项为期6个月的前瞻性研究。患者的平均年龄为4.7岁（39%小于2岁）。最常见的就诊主诉是感冒、耳痛、皮疹、呕吐和腹泻。9%的儿童因外伤前来就诊，10%的儿童体温超过38.2摄氏度。388名儿童（66%）可获得初级保健医生的随访信息。在按时赴约的60%的患者中，42%接受了抗生素治疗，3%被转诊做进一步评估，两名儿童住院治疗。125名儿童（21%）可获得家长的随访信息。111名儿童（19%）没有任何形式的随访信息，265名儿童（45%）没有关于儿童健康状况的随访信息。最后这组儿童中，10%的主诉为外伤，6%体温超过39摄氏度。该组中49%的患者小于2岁。
