Gravel Jocelyn, Gouin Serge, Carrière Benoit, Gaucher Nathalie, Bailey Benoit
CJEM. 2013 Sep;15(5):289-99. doi: 10.2310/8000.2013.130939.
To assess the prevalence of an unfavourable outcome among children leaving without being seen by a physician in the emergency department (ED).
This was a prospective cohort study conducted over a complete year in a pediatric tertiary care ED. A random sample of all children younger than 19 years of age who left without being seen by a physician was contacted by phone 4 to 6 days following the ED visit. The primary outcome was the occurrence of an unfavourable outcome prospectively defined using a Delphi method among 15 pediatric emergency physicians. An unfavourable outcome was defined as hospitalization, the need for an invasive procedure (intravenous or intramuscular medication, fracture reduction, bone casting, or surgical intervention), suicide attempt, or death in the 72 hours following leaving without being seen by a physician. As a secondary outcome, multiple potential predictors were evaluated. The first analysis evaluated the proportion of unfavourable outcomes among children who left without being seen by a physician. Then logistic regression identified predictors of unfavourable outcomes.
During the study period, 61,909 children presented to the ED, 7,592 (12%) left without being seen by a physician, and 1,579 were recruited. Thirty-eight (2.4%; 95% CI 1.7-3.2) patients fulfilled the criteria for an unfavourable outcome. On multiple logistic regression, chief complaints related to trauma and absence of nurse counseling had higher risks of unfavourable outcome.
Approximately 2% of children who left without being seen by a physician at a tertiary care pediatric ED had an unfavourable outcome.
评估在急诊科未就诊即离开的儿童中不良结局的发生率。
这是一项在儿科三级护理急诊科进行的为期一整年的前瞻性队列研究。对所有19岁以下未就诊即离开的儿童进行随机抽样，并在急诊就诊后4至6天通过电话联系。主要结局是采用德尔菲法由15名儿科急诊医生前瞻性定义的不良结局的发生情况。不良结局定义为在未就诊即离开后的72小时内住院、需要进行侵入性操作（静脉或肌肉注射药物、骨折复位、打石膏或手术干预）、自杀未遂或死亡。作为次要结局，评估了多个潜在预测因素。首次分析评估了未就诊即离开的儿童中不良结局的比例。然后通过逻辑回归确定不良结局的预测因素。
在研究期间，61,909名儿童到急诊科就诊，7,592名（12%）未就诊即离开，1,579名被纳入研究。38名（2.4%；95%置信区间1.7 - 3.2）患者符合不良结局标准。在多因素逻辑回归分析中，与创伤相关的主要诉求以及缺乏护士咨询的儿童出现不良结局的风险更高。
在儿科三级护理急诊科未就诊即离开的儿童中，约2%有不良结局。
