Takeuchi Shinya, Funakoshi Hiraku, Nakashima Yoshiyuki, Homma Yosuke, Takahashi Jin, Shiga Takashi
Department of Emergency and Critical Care Medicine Tokyo Bay Urayasu-Ichikawa Medical Center Urayasu Japan.
Department of Emergency Medicine Teikyo University Itabashi Japan.
Acute Med Surg. 2019 Feb 19;6(2):145-151. doi: 10.1002/ams2.395. eCollection 2019 Apr.
Little evidence on Japanese frequent presenters (FPs) is available. Therefore, this retrospective cohort study compared characteristics between FPs and non-frequent presenters (NFPs) in emergency departments (EDs) in Japan.
Frequent presenters included those who presented to an ED ≥4 times during the study period from August 1, 2012 to July 21, 2013. The primary outcomes were triage level and disposition. Secondary outcomes were ED length of stay, method of arrival, and discharge diagnosis.
During the study period, 195 FPs had 1,154 visits to the ED, compared to 15,953 visits by 13,838 NFPs. The sex distribution between FPs and NFPs was comparable (107 men [54.9%] versus 7,070 men [51.1%], respectively; = 0.29), but the mean age was significantly higher in the FP group (57.3 versus 46.5 years, respectively; < 0.0001). Among the FPs, the rate of free governmental health insurance was higher than that of those who pay 30% of health costs (35 patients paid 0% [79.5%] versus 109 patients paid 30% [42.6%], respectively). Condition severity (FP, 84 severe cases [7.28%]; NFP, 1,320 severe cases [8.27%], respectively) and rate of admission (FP, 207 admissions [17.9%]; NFP, 2,987 admissions [18.7%], respectively) were comparable between the groups, although the rate of ambulance use was lower for the FP group. The most frequent diagnostic codes (International Classification of Diseases, 10th Revision) in the FP group were "symptoms and signs".
Triage levels and hospital admission rates were not significantly different between FPs and NFPs in this single-center study in Japan.
关于日本频繁就诊者（FPs）的证据较少。因此，这项回顾性队列研究比较了日本急诊科（EDs）中频繁就诊者与非频繁就诊者（NFPs）的特征。
频繁就诊者包括在2012年8月1日至2013年7月21日研究期间到急诊科就诊≥4次的患者。主要结局是分诊级别和处置方式。次要结局是急诊科停留时间、到达方式和出院诊断。
在研究期间，195名频繁就诊者到急诊科就诊1154次，相比之下，13838名非频繁就诊者就诊15953次。频繁就诊者与非频繁就诊者的性别分布相当（分别为107名男性[54.9%]和7070名男性[51.1%]；P = 0.29），但频繁就诊者组的平均年龄显著更高（分别为57.3岁和46.5岁；P < 0.0001）。在频繁就诊者中，政府免费医疗保险的比例高于支付30%医疗费用的人群（分别为35名患者支付0%[79.5%]和109名患者支付30%[42.6%]）。两组之间的病情严重程度（频繁就诊者，84例重症[7.28%]；非频繁就诊者，1320例重症[8.27%]）和入院率（频繁就诊者，207例入院[17.9%]；非频繁就诊者，2987例入院[18.7%]）相当，尽管频繁就诊者组的救护车使用率较低。频繁就诊者组中最常见的诊断编码（国际疾病分类，第10版）是“症状和体征”。
在日本的这项单中心研究中，频繁就诊者与非频繁就诊者之间的分诊级别和住院率没有显著差异。
