School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia.
Emerg Med Australas. 2022 Apr;34(2):169-175. doi: 10.1111/1742-6723.13832. Epub 2021 Jul 19.
To retrospectively profile the ED usage for a cohort of adults with cerebral palsy (CP).
Five years of ED data from a Victorian hospital network was analysed to identify participants with CP using the Victorian Emergency Minimum Dataset supplemented with scrutiny of inpatient admission data to identify cases because of limited ED coding of CP. Presentation frequency, emergency diagnoses (International Classification of Diseases, 10th Revision codes) and presentation sequelae were calculated and described. An investigation into rates of low urgency presentations was conducted. Differences between adult and paediatric cohorts were described.
Participants with CP constituted 1586 ED presentations. Adults represented 43% (n = 689) of these. Thirty percent of adults presented more than five times over the study period, with respiratory (25%), gastrointestinal (17%) and epilepsy/convulsion diagnoses (11%) being the most common presentations. Rates of inpatient hospital admissions from the ED increased with age in adults (P < 0.001). Low urgency presentations made up 8.9% of total adult presentations.
The high rates of respiratory diagnoses and epilepsy/convulsions, both ambulatory care-sensitive conditions, may be indicative of transitional challenges between paediatric and adult healthcare, potentially highlighting difficulties in accessing primary care services. Relatively low rates of 'low urgency' presentations may suggest perceived medical fragility in this vulnerable population. People with CP who present to ED and were not admitted may be underrepresented in this data. National expansion of this research will aid the development of an evidence-based model of care for CP in Australia.
回顾性分析一组脑瘫（CP）成人患者的急诊科就诊情况。
对维多利亚州一家医院网络的 5 年急诊科数据进行分析，使用维多利亚州急救最低数据集识别 CP 患者，并结合住院患者入院数据进行仔细检查，以确定因急诊科 CP 编码有限而导致的病例。计算并描述就诊频率、急诊诊断（国际疾病分类第 10 版编码）和就诊后果。对低紧急程度就诊率进行了调查。描述了成人和儿科队列之间的差异。
CP 患者构成了 1586 次急诊科就诊。其中成年人占 43%（n=689）。30%的成年人在研究期间就诊超过 5 次，最常见的就诊原因是呼吸系统（25%）、胃肠道（17%）和癫痫/抽搐诊断（11%）。成年人从急诊科住院的比例随年龄增长而增加（P<0.001）。低紧急程度就诊占所有成年就诊的 8.9%。
呼吸系统诊断和癫痫/抽搐的高发病率，这两种疾病都是可在门诊治疗的疾病，可能表明在儿科和成人医疗保健之间存在过渡挑战，可能表明在获得初级保健服务方面存在困难。在这个弱势群体中，相对较低的“低紧急”就诊率可能表明人们认为他们的身体状况脆弱。在这些数据中，可能没有包括到急诊科就诊但未住院的 CP 患者。在澳大利亚，全国范围内扩大这项研究将有助于为 CP 制定基于证据的护理模式。
