Nihira Takashi, Ihara Takateru, Sasaoka Yuta, Hagiwara Yusuke
Department of Pediatric Emergency Care and Intensive Care Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, JPN.
Department of Emergency Medicine, Shonan Kamakura General Hospital, Kamakura, JPN.
Cureus. 2024 Dec 7;16(12):e75277. doi: 10.7759/cureus.75277. eCollection 2024 Dec.
Aim Preventing leaving-without-being-seen (LWBS) in children is crucial due to their inability to seek medical care independently. Because there are no studies of LWBS in Japan, the extent of this problem in Japan and its impacts on healthcare are uncertain. The present study seeks to fill this gap by investigating LWBS after triage and identifying the associated factors. Methods The present, retrospective cohort study was conducted using an electronic, administrative database at a tertiary pediatric medical center in Japan. All records of children aged 15 years or less presenting to the emergency department between April 1, 2014 and March 31, 2017 were included, and the factors associated with LWBS were analyzed. Results During the study period, 112,059 patients were registered, of whom 168 (0.15%) were identified as having LWBS. Several factors were associated with LWBS, including less urgent acuity (odds ratio [OR]: 2.33) and visits on weekends/holidays (OR: 1.71) and evenings (OR: 1.44). Increased emergency department length of stay (EDLOS) and wait time were also associated with increased LWBS (OR: 3.48 for EDLOS > one hour; OR: 41.93 for waiting time > one hour). Conclusion Low acuity; visits on weekends/holidays, and evenings; EDLOS of more than one hour; and waiting time of more than one hour were associated with LWBS. These findings were in line with those of previous studies conducted in other countries, suggesting that they might be highly generalizable.
目的 由于儿童无法独立寻求医疗护理，防止儿童擅自离院（LWBS）至关重要。由于日本尚无关于LWBS的研究，因此该问题在日本的严重程度及其对医疗保健的影响尚不确定。本研究旨在通过调查分诊后的LWBS并确定相关因素来填补这一空白。方法 本回顾性队列研究使用日本一家三级儿科医疗中心的电子行政数据库进行。纳入了2014年4月1日至2017年3月31日期间到急诊科就诊的所有15岁及以下儿童的记录，并分析了与LWBS相关的因素。结果 在研究期间，共登记了112,059例患者，其中168例（0.15%）被确定为LWBS。几个因素与LWBS相关，包括病情紧急程度较低（比值比[OR]：2.33）、在周末/节假日就诊（OR：1.71）和晚上就诊（OR：1.44）。急诊科住院时间（EDLOS）和等待时间的增加也与LWBS的增加相关（EDLOS>1小时时OR：3.48；等待时间>1小时时OR：41.93）。结论 病情紧急程度低；在周末/节假日和晚上就诊；EDLOS超过1小时；以及等待时间超过1小时与LWBS相关。这些发现与其他国家先前的研究结果一致，表明它们可能具有很高的普遍性。
