Rintaari Kenneth M, Kimani Rachel Wangari, Musembi Horatius Malilu, Gatimu Samwel Maina
School of Nursing and Midwifery, Aga Khan University, 00623 Nairobi, Kenya.
Accident and Emergency Department, Aga Khan University Hospital, 00100 Nairobi, Kenya.
Afr J Emerg Med. 2021 Jun;11(2):242-247. doi: 10.1016/j.afjem.2021.03.003. Epub 2021 Apr 5.
Patients' unscheduled return visits (URVs) to the paediatric emergency Centre (PEC) contribute to overcrowding and affect health service delivery and overall quality of care. This study assessed the characteristics and outcomes of paediatric patients with URVs (within 72 hours) to the PEC at a private tertiary hospital in Kenya.
We conducted a retrospective chart review of all URVs within 72 hours among paediatric patients aged ≤15 years between 1 July and 31 December 2018 at the tertiary hospital in Nairobi, Kenya.
During the study period, 1.6% (=172) of patients who visited the PEC returned within 72 hours, with 4.7% revisiting the PEC more than once. Patients' median age was 36 months (interquartile range: 42 months); over half were male (51.7%), 55.8% were ambulatory and 84.3% were insured. In addition, 21% (=36) had chronic diseases and 7% (=12) had drug allergies. Respiratory (59.5%) and gastrointestinal (21.5%) tract infections were the most common diagnoses. Compared with the first visit, more patients with URVs were classified as urgent (1.7% vs. 5.2%) and were non-ambulatory (44.2% vs. 49.5%, =<0.001); 18% of these patients were admitted. Of these 58% were male, 83.9% were aged 0-5 years, 12.9% were classified as urgent, 64.5% had respiratory tract infections and 16.1% had gastrointestinal tract infections. Being admitted was associated with patient acuity (=0.004), laboratory tests (=<0.001) and ambulatory status (=0.041).
The URV rate is low in our setting. Patients who returned to the PEC within 72 hours tended to be male, under 5 years old and insured. Many were non-urgent cases with diagnoses of respiratory and gastrointestinal tract infections. The findings suggest that some URVs were necessary and may have contributed to better care and improved outcomes while others highlight a need for effective patient education and comprehensive initial assessment.
儿科急诊中心（PEC）的患者非计划复诊（URV）导致了过度拥挤，并影响了医疗服务的提供以及整体护理质量。本研究评估了肯尼亚一家私立三级医院儿科患者72小时内非计划复诊至PEC的特征和结果。
我们对2018年7月1日至12月31日期间肯尼亚内罗毕三级医院15岁及以下儿科患者72小时内的所有非计划复诊进行了回顾性病历审查。
在研究期间，就诊于PEC的患者中有1.6%（=172例）在72小时内复诊，其中4.7%的患者多次复诊至PEC。患者的中位年龄为36个月（四分位间距：42个月）；超过一半为男性（51.7%），55.8%为非卧床患者，84.3%有保险。此外，21%（=36例）患有慢性病，7%（=12例）有药物过敏。呼吸道感染（59.5%）和胃肠道感染（21.5%）是最常见的诊断。与首次就诊相比，非计划复诊患者中更多被归类为紧急情况（1.7%对5.2%）且为非卧床患者（44.2%对49.5%，P<0.001）；这些患者中有18%被收治。在这些被收治患者中，58%为男性，83.9%年龄在0至5岁之间，12.9%被归类为紧急情况，64.5%患有呼吸道感染，16.1%患有胃肠道感染。被收治与患者病情严重程度（P=0.004）、实验室检查（P<0.001）和非卧床状态（P=0.041）相关。
在我们的研究环境中，非计划复诊率较低。72小时内返回PEC的患者往往为男性、5岁以下且有保险。许多是非紧急病例，诊断为呼吸道和胃肠道感染。研究结果表明，一些非计划复诊是必要的，可能有助于提供更好的护理并改善结果，而其他结果则凸显了有效患者教育和全面初始评估的必要性。
