School of Health and Related Research, The University of Sheffield, Sheffield, UK
School of Health and Related Research, The University of Sheffield, Sheffield, UK.
Emerg Med J. 2022 Jan;39(1):17-22. doi: 10.1136/emermed-2021-211431. Epub 2021 Oct 28.
A significant proportion of ED attendances in children may be non-urgent attendances (NUAs), which could be better managed elsewhere. This study aimed to quantify NUAs and urgent attendances (UAs) in children to ED and determine which children present in this way and when.
Dataset extracted from the CUREd research database containing linked data on the provision of care in Yorkshire and Humber. Analysis focused on children's ED attendances (April 2014-March 2017). Summary statistics and odds ratios (OR) comparing NUAs and UAs were examined by: age, mode and time of arrival and deprivation alongside comparing summary statistics for waiting, treatment and total department times.
NUAs were more likely in younger children: OR for NUA in children aged 1-4 years, 0.82 (95% CI: 0.80 to 0.83), age 15 years, 0.39 (95% CI: 0.38 to 0.40), when compared with those under 1 year. NUAs were more likely to arrive out of hours (OOHs) compared with in hours: OR 1.19 (95% CI 1.18 to 1.20), and OOHs arrivals were less common in older children compared with those under 1 year: age 1-4 years, 0.87 (95% CI: 0.84 to 0.89) age 15 years, 0.66 (95% CI: 0.63 to 0.69). NUAs also spent less total time in the ED, with a median (IQR) of 98 min (60-147) compared with 127 min (80-185) for UAs.
A substantial proportion of ED attendances in children are NUAs. Our data suggest there are particular groups of children for whom targeted interventions would be most beneficial. Children under 5 years would be such a group, particularly in providing accessible, timely care outside of usual community care opening hours.
在儿童中，相当一部分 ED 就诊可能是非紧急就诊（NUA），这些就诊可以在其他地方得到更好的管理。本研究旨在量化儿童 ED 就诊中的 NUA 和紧急就诊（UA），并确定以这种方式就诊的儿童及其就诊时间。
从包含约克郡和亨伯地区护理提供数据的 CUREd 研究数据库中提取数据集。分析重点是儿童 ED 就诊（2014 年 4 月至 2017 年 3 月）。通过年龄、就诊模式和到达时间以及贫困程度，比较 NUA 和 UA 的汇总统计数据和优势比（OR），并比较等待、治疗和整个部门时间的汇总统计数据。
年龄较小的儿童更有可能出现 NUA：年龄在 1-4 岁的儿童 NUA 的 OR 为 0.82（95%CI：0.80 至 0.83），年龄在 15 岁的儿童 OR 为 0.39（95%CI：0.38 至 0.40），与 1 岁以下儿童相比。与在工作时间就诊相比，NUA 更有可能在工作时间之外（OOHs）就诊：OR 为 1.19（95%CI 1.18 至 1.20），并且 OOHs 就诊在年龄较大的儿童中比 1 岁以下儿童更少见：年龄在 1-4 岁的儿童 OR 为 0.87（95%CI：0.84 至 0.89），年龄在 15 岁的儿童 OR 为 0.66（95%CI：0.63 至 0.69）。NUA 在 ED 中的总时间也较短，中位数（IQR）为 98 分钟（60-147），而 UA 为 127 分钟（80-185）。
儿童 ED 就诊中相当一部分是 NUA。我们的数据表明，有特定的儿童群体可以从有针对性的干预措施中获益最大。5 岁以下的儿童就是这样一个群体，特别是在提供可及、及时的社区护理之外的护理方面。
