Grossman Devin, Kunkov Sergey, Kaplan Carl, Crain Ellen F
Lewis M. Fraad Department of Pediatrics (Emergency Medicine), Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Pediatr Emerg Care. 2013 Jun;29(6):726-8. doi: 10.1097/PEC.0b013e318294dd98.
The objective of this study was to compare admission rates and medical interventions among children whose caregivers called their child's primary care provider (PCP) before taking an ambulance to the pediatric emergency department (PED) versus those who did not.
This was a prospective cohort study of patients brought to an urban, public hospital PED via emergency medical system (EMS). Children were included if the caregiver called 911 to have them transported via EMS and was present in the PED. The main variable was whether the child's PCP was called before EMS utilization. Study outcomes were medical interventions, such as intravenous line insertion or laboratory tests, and hospital admission. χ Test and logistic regression were used to evaluate the relationship of the main variable to the study outcomes.
Six hundred fourteen patients met inclusion criteria and were enrolled. Five hundred eighty-five patients (95.3%) were reported to have a PCP. Seventy-four caregivers (12.1%) called their child's PCP before calling EMS. Two hundred seventy-seven patients (45.1%) had medical interventions performed; of these, 42 (15.2%) called their PCP (P = 0.03). Forty-two patients (6.8%) were admitted; among these, 14 (33.3%) called their PCP (P < 0.01). Adjusting for triage level, patients whose caregiver called the PCP before calling EMS were 3.2 times (95% confidence interval, 1.9-5.2 times) more likely to be admitted and 1.7 times (95% confidence interval, 1.1-2.9 times) more likely to have a medical intervention compared with patients whose caregivers did not call their child's PCP.
Children were more likely to be admitted or require a medical intervention if their caregiver called their PCP before calling EMS. The availability of a PCP for telephone triage may help to optimize EMS utilization.
本研究的目的是比较在乘坐救护车前往儿科急诊科（PED）之前，其照顾者致电孩子的初级保健提供者（PCP）的儿童与未致电者之间的入院率和医疗干预情况。
这是一项对通过紧急医疗系统（EMS）送至城市公立医院PED的患者进行的前瞻性队列研究。如果照顾者拨打911要求通过EMS运送孩子且在PED中，则将这些儿童纳入研究。主要变量是在使用EMS之前是否致电孩子的PCP。研究结果包括医疗干预措施，如静脉置管或实验室检查，以及住院情况。采用χ检验和逻辑回归来评估主要变量与研究结果之间的关系。
614名患者符合纳入标准并被纳入研究。据报告，585名患者（95.3%）有PCP。74名照顾者（12.1%）在拨打EMS之前致电了孩子的PCP。277名患者（45.1%）接受了医疗干预；其中，42名（15.2%）致电了他们的PCP（P = 0.03）。42名患者（6.8%）入院；其中，14名（33.3%）致电了他们的PCP（P < 0.01）。在调整分诊级别后，与照顾者未致电孩子PCP的患者相比，照顾者在拨打EMS之前致电PCP的患者入院可能性高3.2倍（95%置信区间，1.9 - 5.2倍），接受医疗干预的可能性高1.7倍（95%置信区间，1.1 - 2.9倍）。
如果孩子的照顾者在拨打EMS之前致电其PCP，孩子更有可能入院或需要接受医疗干预。PCP可用于电话分诊，这可能有助于优化EMS的使用。
