Department of Emergency Medicine (M Samuels-Kalow), Massachusetts General Hospital, and.
Division of Emergency Medicine (MI Neuman), Boston Children's Hospital, Harvard Medical School, Boston, Mass.
Acad Pediatr. 2019 Nov-Dec;19(8):942-947. doi: 10.1016/j.acap.2019.03.004. Epub 2019 Mar 7.
Adult patients are increasingly receiving care in pediatric emergency departments (PEDs), but little is known about the epidemiology of these visits. The goals of this study were to examine the characteristics of adult patients (≥21 years) treated in PEDs and to describe the variation in resource utilization across centers.
We conducted a cross-sectional study examining visits to 30 PEDs (2012-2016) using the Pediatric Health Information System. Visits were categorized using All Patient Refined Diagnosis Related Groups and compared between age cohorts. We used multivariable logistic models to examine variation in demographics, utilization, testing, treatment, and disposition.
There were 12,958,626 visits to the 30 PEDs over 5 years; 70,636 (0.6%) were by adults. Compared with children, adult patients had more laboratory testing (49% vs 34%), diagnostic imaging (32% vs 29%), and procedures (48% vs 31%), and they were more often admitted (17% vs 11%) or transferred (21% vs 0.7%) (P < .001 for all). In multivariable analysis, older age, black race, Hispanic ethnicity, and private insurance were associated with decreased odds of admission in adults seen in PEDs. Across PEDs, the admission rates (7%-25%) and transfer rates (6%-46%) for adults varied.
Adult patients cared for at PEDs have higher rates of testing, diagnostic imaging, procedures, and admission or transfer. There is wide variation in the care of adults in PEDs, highlighting the importance of further work to identify the optimal approach to adults who present for care in pediatric centers.
越来越多的成年患者在儿科急诊部（PED）接受治疗，但对于这些就诊的流行病学情况知之甚少。本研究的目的是研究在 PED 接受治疗的成年患者（≥21 岁）的特征，并描述各中心之间资源利用的差异。
我们使用儿科健康信息系统对 30 个 PED（2012-2016 年）的就诊情况进行了横断面研究。根据所有患者细化诊断相关组对就诊进行分类，并比较了不同年龄组之间的差异。我们使用多变量逻辑模型来检查人口统计学、利用、检测、治疗和处置方面的差异。
在 5 年内，这 30 个 PED 的就诊次数为 12958626 次；其中 70636 次（0.6%）为成年人就诊。与儿童相比，成年患者的实验室检测（49%对 34%）、诊断性影像学检查（32%对 29%）和操作（48%对 31%）更多，住院（17%对 11%）或转科（21%对 0.7%）的情况也更多（所有 P<0.001）。多变量分析显示，在 PED 就诊的成年患者中，年龄较大、黑人、西班牙裔和私人保险与住院率降低有关。在各个 PED 中，成年患者的住院率（7%-25%）和转科率（6%-46%）存在差异。
在 PED 接受治疗的成年患者的检查、诊断性影像学检查、操作、住院或转科的比例更高。在 PED 中对成年患者的治疗存在很大差异，这突出表明需要进一步努力，以确定为在儿科中心就诊的成年患者提供最佳治疗方法。
