Blair Mitch, Poots Alan J, Lim Valencia, Hiles Stephen, Greenfield Geva, Crehan Caroline, Kugler Beverley, Boreham Charlotte
Department of Paediatrics, Imperial College London, London, UK.
NIHR CLAHRC Northwest London, Imperial College London, London, UK.
Arch Dis Child. 2018 Jan;103(1):19-23. doi: 10.1136/archdischild-2016-311952. Epub 2017 Aug 2.
Unscheduled visits to emergency departments (ED) have increased in the UK in recent years. Children who are repeat attenders are relatively understudied.
To describe the sociodemographic and clinical characteristics of preschoolers who attend ED a large District General Hospital.
METHOD/STUDY DESIGN: Observational study analysing routinely collected ED operational data. Children attending four or more visits per year were considered as 'frequent attenders'. Poisson regression was used with demographic details (age, sex, ethnicity, sociodemographic status) to predict number of attendances seen in the year. We further analysed detailed diagnostic characteristics of a random sample of 10% of attendees.
10 169 patients visited in the 12-month period with 16 603 attendances. 655 individuals attended on 3335 occasions. 6.4% of this population accounted for 20.1% of total visits. In the 10% sample, there were 304 attendances, and 69 (23%) had an underlying chronic long-standing illness (CLSI). This group were 2.4 times more likely to be admitted as inpatients compared with those without such conditions, median length of stay of 6.2 hours versus 2.5 hours (p=NS).
Frequent ED attenders fall broadly into two distinct clinical groups: those who habitually return with self-limiting conditions and those with or without exacerbation of underlying CLSI. Both groups may be amenable to both additional nursing and other forms of community support to enhance self-care and continuity of care. Further research is required to increase our understanding of specific individual family and health system factors that predict repeat attendance in this age group.
近年来，英国急诊科的非预约就诊人数有所增加。对复诊儿童的研究相对较少。
描述在一家大型综合医院急诊科就诊的学龄前儿童的社会人口学和临床特征。
方法/研究设计：一项观察性研究，分析常规收集的急诊科运营数据。每年就诊4次或更多次的儿童被视为“频繁就诊者”。使用泊松回归分析人口统计学细节（年龄、性别、种族、社会人口学状况）来预测当年的就诊次数。我们进一步分析了10%就诊者的随机样本的详细诊断特征。
在12个月期间，有10169名患者就诊，共16603人次。655人就诊3335次。这部分人群占总就诊人数的6.4%，却占总就诊次数的20.1%。在10%的样本中，有304人次就诊，其中69人（23%）患有潜在的慢性长期疾病（CLSI）。与没有此类疾病的患者相比，这组患者住院的可能性高2.4倍，住院时间中位数为6.2小时，而无此类疾病患者为2.5小时（p=无显著差异）。
频繁就诊的急诊科患者大致可分为两个不同的临床组：一类是习惯性因自限性疾病复诊的患者，另一类是潜在CLSI有或无病情加重的患者。这两组患者都可能受益于额外的护理和其他形式的社区支持，以加强自我护理和护理的连续性。需要进一步研究，以加深我们对预测该年龄组复诊的特定个体、家庭和卫生系统因素的理解。
