Department of Emergency Medicine, North Shore University Hospital.
The Feinstein Institute for Medical Research, Northwell Health System, Manhasset.
Pediatr Emerg Care. 2020 Jul;36(7):309-311. doi: 10.1097/PEC.0000000000001386.
The objective of this study was to analyze the characteristics of pediatric patients transferred from a hospital-based general emergency department (ED) to an acute care facility.
Study data were abstracted from the 2010 Healthcare Cost and Utilization Project Nationwide Emergency Department Sample database. A multivariate logistic regression was constructed for pediatric patients (<18 years old) who require a transfer to an acute care facility from a general ED. Independent variables included in the model were age (<1, 1-4, 5-9, 10-14, 15-17 age in years), sex, insurance/payment method, and diseases/body systems using International Classification of Diseases, Ninth Revision, coding.
In the Healthcare Cost and Utilization Project/Nationwide Emergency Department Sample, 5.5 million ED visits were for children less than 18 years. About 1.5% of visits resulted in transfer. Children younger than 1 year had higher transfer rates as compared with 15 to 17 year old group (odds ratio [OR], 1.17; 95% confidence interval [CI], 1.089-1.146). Patients with Medicaid and self-pay compared with private insurance/health maintenance organization had 4% (OR, 0.96; 95% CI, 0.944-0.976) and 9% (OR, 0.91; 95% CI, 0.886-0.945), respectively, lower likelihood of being transferred. Patients with circulatory (OR, 8.43; 95% CI, 7.8-9.1), endocrine (OR, 5.9; 95% CI, 5.6-6.2), mental (OR, 5.44; 95% CI, 5.3-5.6), nervous system (OR, 5.2; 95% CI, 4.9-5.5), congenital anomalies (OR, 5.14; 95% CI, 4.5-5.9), hematology-oncology (OR, 4.49; 95% CI, 4.2-4.8), digestive, (OR, 1.52; 95% CI, 1.5-1.6), and other disorders (OR, 1.33; 95% CI, 1.3-1.4) had a higher odds of being transferred as compared with trauma/injury and poisoning, whereas patients with disorders related to genitourinary (OR, 0.96; 95% CI, 0.91-1.0), respiratory (OR, 0.79; 95% CI, 0.77-0.81), musculoskeletal (OR, 0.63; 95% CI, 0.58-0.68), skin (OR, 0.47; 95% CI, 0.45-0.50), infectious and parasitic (OR, 0.23; 95% CI, 0.22-0.25), and eyes/ears/nose/throat (OR, 0.09; 95% CI, 0.079-0.094) had a lower odds of being transferred as compared with trauma/injury and poisoning.
Children younger than 1 year had relatively higher transfer rates. Patients covered by Medicaid and self-pay had the lowest likelihood of transfer. Transfer rates varied significantly by condition and the high-transfer diagnostic categories were related to circulatory, endocrine, nervous, hematology-oncology, and mental disorders as well as congenital anomalies, which may be related to a lack of ED or inpatient resources to care for children with problems that require more complex care.
本研究旨在分析从医院综合急诊部（ED）转至急性护理机构的儿科患者的特征。
研究数据从 2010 年医疗保健成本和利用项目全国急诊部样本数据库中提取。对于需要从一般 ED 转至急性护理机构的儿科患者（<18 岁），构建了多变量逻辑回归模型。模型中包含的自变量包括年龄（<1、1-4、5-9、10-14、15-17 岁）、性别、保险/支付方式以及使用国际疾病分类，第九版，编码的疾病/身体系统。
在医疗保健成本和利用项目/全国急诊部样本中，有 550 万 ED 就诊是为了治疗年龄小于 18 岁的儿童。约有 1.5%的就诊需要转院。与 15 至 17 岁组相比，年龄小于 1 岁的儿童转院率更高（比值比[OR]，1.17；95%置信区间[CI]，1.089-1.146）。与私人保险/健康维护组织相比，医疗补助和自付的患者转院的可能性分别低 4%（OR，0.96；95% CI，0.944-0.976）和 9%（OR，0.91；95% CI，0.886-0.945）。患有循环系统（OR，8.43；95% CI，7.8-9.1）、内分泌系统（OR，5.9；95% CI，5.6-6.2）、精神（OR，5.44；95% CI，5.3-5.6）、神经系统（OR，5.2；95% CI，4.9-5.5）、先天性异常（OR，5.14；95% CI，4.5-5.9）、血液肿瘤学（OR，4.49；95% CI，4.2-4.8）、消化系统（OR，1.52；95% CI，1.5-1.6）和其他疾病（OR，1.33；95% CI，1.3-1.4）的患者转院的可能性更高，而与创伤/损伤和中毒相比，患有与泌尿生殖系统（OR，0.96；95% CI，0.91-1.0）、呼吸系统（OR，0.79；95% CI，0.77-0.81）、肌肉骨骼系统（OR，0.63；95% CI，0.58-0.68）、皮肤（OR，0.47；95% CI，0.45-0.50）、传染性和寄生虫病（OR，0.23；95% CI，0.22-0.25）和眼部/耳部/鼻子/喉咙（OR，0.09；95% CI，0.079-0.094）的患者转院的可能性较低。
年龄小于 1 岁的儿童转院率相对较高。医疗补助和自付的患者转院的可能性最低。转院率因病情而异，高转院诊断类别与循环系统、内分泌系统、神经系统、血液肿瘤学和精神障碍以及先天性异常有关，这可能与 ED 或住院部门缺乏资源有关，无法为需要更复杂治疗的儿童提供护理。
