Reiner Ethan, Ahmadi Ardalan, Grafstein Eric, Doan Quynh
Department of Pediatrics, Children's Hospital of British Columbia.
Department of Emergency Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada.
Pediatr Emerg Care. 2019 Mar;35(3):185-189. doi: 10.1097/PEC.0000000000001013.
Existing pediatric literature describing repeat visits to the emergency department (ED) for the same medical complaint has yet to report on patient flow patterns from general EDs (GEDs) to a pediatric ED (PED). We sought to characterize the population of patients who are treated in a GED and subsequently present to a PED for further care.
We conducted a retrospective cohort study reviewing all pediatric visits (age < 17 y) at 5 GEDs in Vancouver. Our primary outcome measure was the proportion of visits with a subsequent visit to a PED (<7 days) during the 2012 to 2013 fiscal year. Secondary outcomes included reasons for PED consultation, the clinical services accessed, and disposition at the PED.
During the study period, 581 (3.3%) of the 17,824 children seen at GEDs subsequently presented to the PED within 7 days. The top 3 diagnoses among these were fracture, viral infection, and musculoskeletal complaints. Of the 581 children with a visit to the PED, 180 (31.0%) were referred to the PED for a consultation, whereas the rest were family initiated. Referred visits were more frequently associated with pediatric subspecialist consultation than family-initiated visits (45.0% vs 19.5%, P < 0.01). The referred group more frequently resulted in a surgical procedure (13.9% vs 2.5%, P < 0.01) or hospital admission (51.7% vs 8.7%, P < 0.01).
Knowing the proportion, management, and outcomes of children who are treated in a GED and subsequently at a PED may provide an important quality measure and opportunities to improve the management of common pediatric emergencies in the community.
现有描述因相同医疗诉求多次前往急诊科（ED）就诊的儿科文献，尚未报道从综合急诊科（GED）到儿科急诊科（PED）的患者流向模式。我们试图描述在GED接受治疗并随后前往PED接受进一步治疗的患者群体特征。
我们进行了一项回顾性队列研究，回顾了温哥华5家GED的所有儿科就诊病例（年龄<17岁）。我们的主要结局指标是在2012至2013财年期间，后续前往PED就诊（<7天）的就诊比例。次要结局包括前往PED咨询的原因、获得的临床服务以及在PED的处置情况。
在研究期间，在GED就诊的17824名儿童中，有581名（3.3%）随后在7天内前往PED就诊。其中前三大诊断为骨折、病毒感染和肌肉骨骼疾病。在581名前往PED就诊的儿童中，180名（31.0%）是被转诊至PED进行咨询，其余为家属主动前往。与家属主动前往的就诊相比，被转诊的就诊与儿科专科会诊的相关性更高（45.0%对19.5%，P<0.01）。被转诊组更常导致手术治疗（13.9%对2.5%，P<0.01）或住院治疗（51.7%对8.7%，P<0.01）。
了解在GED接受治疗并随后在PED接受治疗的儿童的比例、管理和结局，可能为改善社区常见儿科急诊的管理提供重要的质量指标和机会。
