Harvard Medical School, Boston, Massachusetts.
Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.
West J Emerg Med. 2024 May;25(3):407-414. doi: 10.5811/westjem.18399.
BACKGROUND/OBJECTIVE: Asthma is a common chronic medical condition among children and the most common diagnosis associated with interfacility transports for pediatric patients. As many as 40% of pediatric transfers may be unnecessary, resulting in potential delays in care and unnecessary costs. Our objective was to identify the patient-related factors associated with potentially unnecessary transfers for pediatric patients with asthma.
We used patient care data from the California Department of Health Care Access and Information patient discharge and emergency department (ED) datasets to capture ED visits where a pediatric patient (age 2-17 years) presented with asthma and was transferred to another ED or acute care hospital. The outcome of interest was a potentially unnecessary transfer, defined as a visit where length of stay after transfer was <24 hours and no advanced services were used, such as respiratory therapy or critical care. Patient-related characteristics were extracted, including age, gender, race/ethnicity, primary language, insurance status, and clinical characteristics. First, we used descriptive statistics to compare necessary vs unnecessary transfers. Second, we used generalized estimating equations accounting for clustering by ED to estimate odds ratios (OR) and identify factors associated with potentially unnecessary transfers.
A total of 4,233 pediatric ED patients were transferred with a diagnosis of asthma, including 461 (11%) transfers that met criteria as potentially unnecessary. Median age was 12 years (interquartile range 7-15), and 46% were female. Factors associated with increased odds of potentially unnecessary transfer while controlling for key factors included younger age (eg, 2-5 years, OR 2.0, 95% confidence interval [CI] 1.4-2.9), male gender (OR 1.4, 95% CI 1.1-1.7), and Hispanic ethnicity (OR 1.6, 95% CI 1.2-2.1), while multiple hospitalizations for asthma per year was associated with decreased odds (OR 0.2, 95% CI 0.1-0.4).
Several patient-related factors were associated with increased or decreased odds of potentially unnecessary transfers among pediatric patients presenting to the ED with asthma. These factors can be considered in future work to better understand, predict, and reduce unnecessary transfers and their negative consequences.
背景/目的：哮喘是儿童常见的慢性疾病，也是与儿科患者转运相关的最常见诊断。多达 40%的儿科转运会不必要，导致潜在的治疗延误和不必要的费用。我们的目的是确定与哮喘儿科患者潜在不必要转运会相关的患者相关因素。
我们使用来自加利福尼亚州卫生保健获取和信息患者出院和急诊部（ED）数据集的患者护理数据，以捕获 ED 就诊，其中儿科患者（年龄 2-17 岁）出现哮喘并转至另一个 ED 或急性护理医院。感兴趣的结果是潜在的不必要的转院，定义为转院后住院时间<24 小时且未使用高级服务（如呼吸治疗或重症监护）的转院。提取了患者相关特征，包括年龄、性别、种族/民族、主要语言、保险状况和临床特征。首先，我们使用描述性统计来比较必要与不必要的转院。其次，我们使用广义估计方程，考虑 ED 聚类，估计比值比（OR）并确定与潜在不必要转院相关的因素。
共有 4233 名儿科 ED 患者因哮喘诊断而转院，其中 461 例（11%）转院符合潜在不必要的标准。中位年龄为 12 岁（四分位距 7-15 岁），46%为女性。在控制关键因素的情况下，与潜在不必要转院的几率增加相关的因素包括年龄较小（例如，2-5 岁，OR 2.0，95%置信区间[CI]1.4-2.9）、男性（OR 1.4，95%CI 1.1-1.7）和西班牙裔（OR 1.6，95%CI 1.2-2.1），而每年因哮喘多次住院则与几率降低相关（OR 0.2，95%CI 0.1-0.4）。
在因哮喘到 ED 就诊的儿科患者中，有几个患者相关因素与潜在不必要转院的几率增加或降低相关。这些因素可以在未来的工作中考虑，以更好地理解、预测和减少不必要的转院及其负面后果。
