Goto Tadahiro, Hasegawa Kohei, Faridi Mohammad Kamal, Sullivan Ashley F, Camargo Carlos A
Harvard Medical School, Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.
West J Emerg Med. 2017 Oct;18(6):1042-1046. doi: 10.5811/westjem.2017.7.33723. Epub 2017 Sep 26.
Epidemiological surveillance data for emergency department (ED) visits by children are imperative to guide resource allocation and to develop health policies that advance pediatric emergency care. However, there are sparse population-based data on patient-level information (e.g., the number of children who present to the emergency department [ED]). In this context, we aimed to investigate both the patient- and visit-level rates of ED utilization by children.
This was a retrospective cohort study using population-based multipayer data - state ED databases (SEDD) and state inpatient databases (SID) - from six geographically-dispersed U.S. states (California, Florida, Iowa, Nebraska, New York, and Utah) in 2010 and 2011. We identified all children aged <18 years who presented to the ED and described the patient-level ED visit rate, visit-level ED visit rate, and proportion of all ED visits made by children. We conducted the analysis using the 2011 SEDD and SID data. We also repeated the analysis using the 2010 data to determine the consistency of the results across different years.
In 2011, 2.9 million children with a patient identifier presented to EDs in the six U.S. states. At the patient-level, 15 out of every 100 children presented to an ED at least once per year. Of these children, 25% presented to EDs 2-3 times per year with an approximately 1.5-fold variation across the states (e.g., 19% in Utah vs. 28% in Florida). In addition, 5% presented to EDs ≥4 times per year. At the visit-level, 6.7 million ED visits were made by children in 2011 - 34 ED visits per 100 children annually. ED visits by children accounted for 22% of all ED visits (including both adults and children), with a relatively small variation across the states (e.g., 20% in New York vs. 24% in Nebraska). Analysis of the 2010 data gave similar results for the ED utilization by children.
By using large population-based data, we found a substantial burden of ED visits at both patient- and visit-levels. These findings provide a strong foundation for policy makers and professional organizations to strengthen emergency care for children.
儿童急诊科就诊的流行病学监测数据对于指导资源分配和制定推进儿科急诊护理的卫生政策至关重要。然而，基于人群的患者层面信息（例如到急诊科就诊的儿童数量）的数据却很匮乏。在此背景下，我们旨在调查儿童急诊科利用的患者层面和就诊层面的比率。
这是一项回顾性队列研究，使用了来自美国六个地理上分散的州（加利福尼亚州、佛罗里达州、爱荷华州、内布拉斯加州、纽约州和犹他州）2010年和2011年基于人群的多付款人数据——州急诊科数据库（SEDD）和州住院数据库（SID）。我们确定了所有到急诊科就诊的18岁以下儿童，并描述了患者层面的急诊科就诊率、就诊层面的急诊科就诊率以及儿童进行的所有急诊科就诊的比例。我们使用2011年的SEDD和SID数据进行分析。我们还使用2010年的数据重复分析，以确定不同年份结果的一致性。
2011年，在美国六个州有290万带有患者标识符的儿童到急诊科就诊。在患者层面，每100名儿童中有15名每年至少到急诊科就诊一次。在这些儿童中，25%的儿童每年到急诊科就诊2至3次，各州之间的差异约为1.5倍（例如，犹他州为19%，佛罗里达州为28%）。此外，5%的儿童每年到急诊科就诊≥4次。在就诊层面，2011年儿童进行了670万次急诊科就诊——每年每100名儿童就诊34次。儿童的急诊科就诊占所有急诊科就诊（包括成人和儿童）的22%，各州之间的差异相对较小（例如，纽约州为20%，内布拉斯加州为24%）。对2010年数据的分析得出了关于儿童急诊科利用的类似结果。
通过使用基于人群的大量数据，我们发现患者层面和就诊层面的急诊科就诊负担都很重。这些发现为政策制定者和专业组织加强儿童急诊护理提供了坚实的基础。
