Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL.
Division of Pediatric Emergency Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.
Pediatr Emerg Care. 2022 Feb 1;38(2):e983-e987. doi: 10.1097/PEC.0000000000002508.
The aims of the study were to estimate testing and treatment rates among pediatric low-acuity emergency department (ED) visits and to compare testing and treatment patterns at general and pediatric-specific EDs.
We performed a cross-sectional study of triage level 4 or 5 pediatric visits from a complex survey of nonfederal US EDs from 2008 to 2017. We analyzed demographics, vital signs, disposition, testing, and treatment. We calculated proportions for each data element and used χ2 tests to determine differences between general and pediatric EDs.
There were an estimated 306.2 million pediatric visits with 129.1 million acuity level 4 or 5 visits (57.2%; 95% confidence interval, 55.4%-58.9%), with diagnostic testing performed in 47.1% and medications administered in 69.6% of the visits. Most low-acuity visits (82.0%) were to general EDs. Tests performed more frequently in general EDs compared with pediatric EDs included radiographs (25.8% vs 15.7%, P < 0.01), complete blood count (6.4% vs 3.9%, P < 0.01), electrolytes (11.6% vs 3.7%, P < 0.01), and glucose (2.0% vs 0.9%, P < 0.01). Ultrasound was used less frequently in general EDs (0.5 vs 0.7, P < 0.01). There were similar rates of intravenous fluid and overall medication administration and a higher proportion of patients receiving antibiotics in general EDs (28.7% vs 23.8%, P < 0.01).
More than half of pediatric visits to the ED are low acuity. Although general EDs relied on more imaging, blood testing and antibiotics, and pediatric EDs on ultrasound, overall resource utilization was high in this population across both ED types and can likely be reduced.
本研究旨在评估儿科低危急诊科（ED）就诊的检查和治疗率，并比较综合急诊科和儿科急诊科的检查和治疗模式。
我们对 2008 年至 2017 年来自美国非联邦急诊科的复杂调查中的 4 级或 5 级儿科就诊患者进行了横断面研究。我们分析了人口统计学、生命体征、处置、检查和治疗情况。我们计算了每个数据元素的比例，并使用 χ2 检验来确定综合急诊科和儿科急诊科之间的差异。
估计有 3.062 亿次儿科就诊，其中 1.291 亿次为 4 级或 5 级急性就诊（57.2%；95%置信区间，55.4%-58.9%），47.1%的就诊进行了诊断性检查，69.6%的就诊给予了药物治疗。大多数低危就诊（82.0%）是在综合急诊科就诊。与儿科急诊科相比，综合急诊科更常进行的检查包括 X 光检查（25.8%比 15.7%，P < 0.01）、全血细胞计数（6.4%比 3.9%，P < 0.01）、电解质检查（11.6%比 3.7%，P < 0.01）和血糖检查（2.0%比 0.9%，P < 0.01）。综合急诊科使用超声检查的频率较低（0.5%比 0.7%，P < 0.01）。静脉输液和总体药物治疗的比率相似，综合急诊科给予抗生素的患者比例较高（28.7%比 23.8%，P < 0.01）。
超过一半的儿科 ED 就诊为低危就诊。尽管综合急诊科更多地依赖影像学检查、血液检查和抗生素，而儿科急诊科则更多地依赖超声检查，但这两种 ED 类型的整体资源利用率都很高，在该人群中可能会有所降低。
