Scott Jason, Khanom Ashrafunessa, Straw Joanne, Strickland Annette, Porter Alison, Snooks Helen
Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
Swansea University Medical School, Swansea University, Swansea, UK.
Emerg Med J. 2022 Dec 6. doi: 10.1136/emermed-2021-211701.
Frequent use of emergency medical services (EMS) is recognised to be a global phenomenon, although paediatric frequent use is poorly understood. This systematic review aimed to understand how paediatric frequent use of EMS is currently defined, identify factors associated with paediatric frequent use of EMS and determine effectiveness of interventions for paediatric patients who frequently use EMS.
Four electronic databases (Medline, CINAHL, Web of Science and PsycINFO) were searched to September 2022 for primary, peer-reviewed research studies published in English from January 2000. Studies were included that examined frequent use (>1 contact during study period) of EMS or other services with arrival via EMS. Paediatric patients were defined as <18 years of age or otherwise defined by study authors as paediatric/adolescent/children. Data were extracted using a structured proforma, and quality was assessed using the Standard Quality Assessment Criteria for Quantitative Studies but did not influence inclusion decisions. Data were presented using narrative synthesis.
The search resulted in 4172 unique references, with 12 papers included in the review from 7 countries. Four were EMS studies, and eight Emergency Department with arrival via EMS. All studies used retrospective designs, with no interventional studies identified. Paediatric frequent EMS users were more likely to use services for medical reasons rather than trauma, including respiratory complaints, mental health and seizures, but data on gender and ethnicity were inconclusive and silent on socioeconomic status. There was no consistency in definitions of either a paediatric patient or of frequent use.
The broad range of reasons for frequent use suggests that a single intervention is unlikely to be effective at addressing the causes of frequent use. There is a need for further research to better identify the underlying reasons for frequent EMS use among paediatric patients and to develop interventions in this population.
尽管对儿科频繁使用紧急医疗服务（EMS）的情况了解甚少，但频繁使用EMS被认为是一种全球现象。本系统评价旨在了解目前儿科频繁使用EMS是如何定义的，确定与儿科频繁使用EMS相关的因素，并确定针对频繁使用EMS的儿科患者的干预措施的有效性。
检索了四个电子数据库（Medline、CINAHL、Web of Science和PsycINFO），截至2022年9月，查找2000年1月以来以英文发表的经同行评审的原发性研究。纳入的研究考察了EMS的频繁使用（研究期间>1次接触）或通过EMS到达的其他服务。儿科患者定义为年龄<18岁，或研究作者另行定义为儿科/青少年/儿童。使用结构化表格提取数据，并使用定量研究的标准质量评估标准评估质量，但不影响纳入决策。数据采用叙述性综合法呈现。
检索共得到4172篇独特的参考文献，本评价纳入了来自7个国家的12篇论文。4篇是EMS研究，8篇是通过EMS到达急诊科的研究。所有研究均采用回顾性设计，未发现干预性研究。儿科频繁使用EMS的用户更有可能因医疗原因而非创伤使用服务，包括呼吸系统疾病、心理健康问题和癫痫发作，但关于性别和种族的数据尚无定论，且未提及社会经济地位。儿科患者或频繁使用的定义均不一致。
频繁使用的原因多种多样，这表明单一干预措施不太可能有效解决频繁使用的原因。需要进一步研究，以更好地确定儿科患者频繁使用EMS的潜在原因，并针对该人群制定干预措施。
