Pediatric Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
Pediatric Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA; Dept of Pediatrics, Emory University, Atlanta, GA, USA; Department of Emergency Medicine, Emory University.
Am J Emerg Med. 2014 Mar;32(3):199-202. doi: 10.1016/j.ajem.2013.09.018. Epub 2013 Oct 1.
The use of Emergency Medical Services (EMS) for low-acuity pediatric problems is well documented. Attempts have been made to curb potentially unnecessary transports, including using EMS dispatch protocols, shown to predict acuity and needs of adults. However, there are limited data about this in children. The primary objective of this study is to determine the pediatric emergency department (PED) resource utilization (surrogate of acuity level) for pediatric patients categorized as "low-acuity" by initial EMS protocols.
Records of all pediatric patients classified as "low acuity" and transported to a PED in winter and summer of 2010 were reviewed. Details of the PED visit were recorded. Patients were categorized and compared based on chief complaint group. Resource utilization was defined as requiring any prescription medications, labs, procedures, consults, admission or transfer. "Under-triage" was defined as a "low-acuity" EMS transport subsequently requiring emergent interventions.
Of the 876 eligible cases, 801 were included; 392/801 had no resource utilization while 409 of 801 had resource utilization. Most (737/801) were discharged to home; however, 64/801 were admitted, including 1 of 801 requiring emergent intervention (under-triage rate 0.12%). Gastroenterology and trauma groups had a significant increase in resource utilization, while infectious disease and ear-nose-throat groups had decreased resource utilization.
While this EMS system did not well predict overall resource utilization, it safely identified most low-acuity patients, with a low under-triage rate. This study identifies subgroups of patients that could be managed without emergent transport and can be used to further refine current protocols or establish secondary triage systems.
使用紧急医疗服务（EMS）治疗低危儿科疾病已有充分记录。人们已经尝试通过 EMS 调度协议来减少潜在的不必要转运，这些协议已被证明可以预测成人的疾病严重程度和需求。然而，针对儿童的此类数据有限。本研究的主要目的是确定通过初始 EMS 协议归类为“低危”的儿科患者在儿科急诊部（PED）的资源利用情况（代表疾病严重程度）。
回顾了 2010 年冬季和夏季所有归类为“低危”并转运至 PED 的儿科患者的记录。记录了 PED 就诊的详细信息。根据主诉分组对患者进行分类和比较。资源利用定义为需要任何处方药物、实验室检查、操作、会诊、住院或转院。“分诊不足”定义为需要紧急干预的“低危”EMS 转运。
在 876 例符合条件的病例中，有 801 例纳入研究；392/801 例无资源利用，409/801 例有资源利用。大多数（737/801）患者出院回家；然而，有 64/801 例患者住院，包括 1 例（0.12%）需要紧急干预（分诊不足率）。胃肠病学和创伤组的资源利用率显著增加，而传染病和耳鼻喉科组的资源利用率降低。
尽管该 EMS 系统未能很好地预测整体资源利用率，但它安全地识别了大多数低危患者，分诊不足率较低。本研究确定了可无需紧急转运管理的亚组患者，可用于进一步完善现有协议或建立二级分诊系统。
