Alele Faith O, Callander Emily J, Emeto Theophilus I, Mills Jane, Watt Kerrianne
Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.
College of Health, Massey University, Wellington, New Zealand.
J Paediatr Child Health. 2018 Dec;54(12):1341-1347. doi: 10.1111/jpc.14079. Epub 2018 Jun 4.
Despite increasing rates of emergency department (ED) utilisation, little is known about low-acuity presentations in children ≤5 years. The aims of the study were to estimate the proportion and cost of low-acuity presentations in children ≤5 years presenting to the ED and to determine the relative effect of socio-economic status (SES) on paediatric low-acuity presentations at the ED.
This is a retrospective observational study of children ≤5 years presenting to the Cairns Hospital ED over 4 years. A multivariate logistic regression model was used to assess the association between SES and low-acuity presentations. Cost of low-acuity presentations was calculated based on triage score and admission status, using costs obtained from the National Hospital Cost Data Collection.
A total of 23 086 children were included in the study, of whom 56.7% were male (mean age = 1.85 ± 1.63 years). Approximately one-third of ED visits were low-acuity presentations (32.4%), and low-acuity presentations increased progressively with SES. In multivariate analysis, children from families with very high SES were twice as likely to have a low-acuity presentation (odds ratio 2.17; 95% confidence interval, 1.66-2.85). Low-acuity ED presentations cost the health-care system in excess of A$895 000-A$1 110 000 per year.
These findings demonstrate that a significant proportion of paediatric ED visits are of low acuity and that these visits yield a substantial cost to the health system. Further research is required regarding care givers' rationale and potentially other reasons underlying these low-acuity ED presentations.
尽管急诊科（ED）的利用率不断上升，但对于5岁及以下儿童的低 acuity 就诊情况知之甚少。本研究的目的是估计5岁及以下儿童到急诊科就诊的低 acuity 就诊比例和费用，并确定社会经济地位（SES）对急诊科儿科低 acuity 就诊的相对影响。
这是一项对4年间到凯恩斯医院急诊科就诊的5岁及以下儿童的回顾性观察研究。使用多变量逻辑回归模型评估SES与低 acuity 就诊之间的关联。低 acuity 就诊的费用根据分诊评分和入院状态计算，使用从国家医院成本数据收集获得的成本。
共有23086名儿童纳入研究，其中56.7%为男性（平均年龄 = 1.85 ± 1.63岁）。大约三分之一的急诊科就诊为低 acuity 就诊（32.4%），且低 acuity 就诊随着SES的升高而逐渐增加。在多变量分析中，来自SES非常高的家庭的儿童出现低 acuity 就诊的可能性是其他儿童的两倍（优势比2.17；95%置信区间，1.66 - 2.85）。低 acuity 的急诊科就诊每年给医疗保健系统造成超过89.5万澳元至111万澳元的费用。
这些发现表明，相当一部分儿科急诊科就诊为低 acuity，且这些就诊给卫生系统带来了巨大成本。需要进一步研究护理人员的理由以及这些低 acuity 急诊科就诊背后潜在的其他原因。
