Jafari Kaileen, Gupta Apeksha, Caglar Derya, Hartford Emily
Division of Emergency Medicine (K Jafari, D Caglar, and E Hartford), Department of Pediatric, University of Washington, Seattle, Wash; Center for Clinical and Translation Research (K Jafari, A Gupta, D Caglar, and E Hartford), Seattle Children's Hospital, Seattle, Wash.
Center for Clinical and Translation Research (K Jafari, A Gupta, D Caglar, and E Hartford), Seattle Children's Hospital, Seattle, Wash; Children's Core for Biomedical Statistics (A Gupta), Seattle Children's Research Institute, Seattle, Wash.
Acad Pediatr. 2025 Jan-Feb;25(1):102553. doi: 10.1016/j.acap.2024.07.020. Epub 2024 Aug 2.
Acute pediatric respiratory illness is one of the most common reasons for emergency department (ED) transfer; however, few studies have examined predictors of potentially avoidable ED transfer (PAT) in this subpopulation. This study aimed to characterize patterns and predictors of PATs in children with acute respiratory illness.
Cross-sectional analysis of 8,402,577 visits for patients ≤17 years from 2018 to 2019 Health Care Utilization Project State ED and Inpatient Datasets from New York, Maryland, Wisconsin, and Florida. ED transfers matched to a visit at a receiving facility with a primary diagnosis of pneumonia, croup/other upper respiratory infection (URI), bronchiolitis, or asthma were included. PAT was defined as discharge from receiving ED or within 24 hours of inpatient admission without specialized procedures, as previously described. PATs were compared with necessary transfers using a 3-level generalized linear mixed model with adjustment for patient and hospital covariates.
Among 4409 matched respiratory transfers, 25.5% were potentially avoidable. Most PATs originated from EDs within the third highest quartile of annual pediatric ED visits (n = 472, 42.0%). In the multivariable model, the likelihood of PAT was higher for patients with croup/other URI ((odds ratio) OR 2.72 (2.09-3.5) and if referring ED was in the highest quartile of annual pediatric ED volumes (OR 0.48 95% (confidence interval) CI 0.26-0.88).
Pediatric respiratory transfers with a diagnosis of croup/other URI were the most likely to be potentially avoidable. Future implementation efforts to reduce PATs should consider focusing on croup management in EDs in the lower 3 quartiles of pediatric volume.
小儿急性呼吸道疾病是急诊科（ED）转诊的最常见原因之一；然而，很少有研究探讨这一亚人群中潜在可避免的急诊科转诊（PAT）的预测因素。本研究旨在描述急性呼吸道疾病患儿PAT的模式和预测因素。
对2018年至2019年纽约、马里兰州、威斯康星州和佛罗里达州医疗保健利用项目州急诊科和住院患者数据集的8402577例17岁及以下患者就诊情况进行横断面分析。纳入与接收机构就诊匹配的急诊科转诊，其主要诊断为肺炎、喉炎/其他上呼吸道感染（URI）、细支气管炎或哮喘。如前所述，PAT定义为在接收急诊科出院或住院入院后24小时内无需特殊程序。使用三级广义线性混合模型对PAT与必要转诊进行比较，并对患者和医院协变量进行调整。
在4409例匹配的呼吸道转诊中，25.5%可能是可避免的。大多数PAT来自年儿科急诊科就诊量处于第三高四分位数的急诊科（n = 472，42.0%）。在多变量模型中，患有喉炎/其他URI的患者发生PAT的可能性更高（优势比[OR]为2.72[2.09 - 3.5]），如果转诊急诊科处于年儿科急诊科就诊量的最高四分位数，则发生PAT的可能性较低（OR为0.48，95%置信区间[CI]为0.26 - 0.88）。
诊断为喉炎/其他URI的小儿呼吸道转诊最有可能是潜在可避免的。未来减少PAT的实施工作应考虑将重点放在儿科就诊量较低的三个四分位数的急诊科的喉炎管理上。
