Lengeler Noelie, Starvaggi Carl Alessandro, Jaboyedoff Manon, Affentranger Sophie, Keitel Kristina
Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, Bern, Switzerland.
Department of Orthopaedic Surgery, Spitalzentrum Oberwallis, Brig, Switzerland.
BMC Health Serv Res. 2025 Jan 17;25(1):96. doi: 10.1186/s12913-024-12163-w.
Caregiver concern is the main driver to paediatric emergency departments visits. Understanding caregiver worries is crucial to guide patients to the most appropriate healthcare setting. Previous research shows mixed findings on the accordance between caregiver assessment and professional triage.
We assessed data from two questionnaire-based studies conducted over 27 months in two tertiary paediatric emergency departments in Switzerland to compare caregiver perception of their child's medical acuity and standard nurse triage. Furthermore, we examined socioeconomic factors associated with caregiver perception.
Our study of 2,126 children seen in the two paediatric emergency departments showed that caregiver assessment aligned well with the acuity assigned by professional triage in 89% (1,901/2,126) of cases. In 142 cases (7%, 142/2,126), caregivers rating their child's severity higher than nurse's triage while in 83 cases (4%, 83/2,126), they rated it lower. In an univariable analysis, we found that family's difficulties paying bills (20% vs. 12%) and low maternal education (19% vs. 10%) were associated with a higher percentage of caregiver rating their child's severity higher than nurse's triage. Fever as the main complaint was associated with caregiver rating their child's severity lower than nurse's triage.
This questionnaire-based study shows that caregiver's assessment of the severity of the child and nurse triage are concordant in most situations. Our study sheds light on the association between caregiver assessment and professional triage in two paediatric emergency departments in Switzerland, revealing some of the factors leading to discordance. These factors most probably reflect health illiteracy. It is important that healthcare professionals recognize and address factors influencing caregiver assessments to facilitate accurate decision-making and enhanced paediatric emergency care outcomes.
照顾者的担忧是儿童前往急诊科就诊的主要驱动因素。了解照顾者的担忧对于引导患者前往最合适的医疗机构至关重要。先前的研究在照顾者评估与专业分诊的一致性方面得出了不一致的结果。
我们评估了在瑞士两个三级儿科急诊科进行的两项基于问卷的研究的数据，以比较照顾者对其孩子病情严重程度的认知与护士的标准分诊。此外，我们研究了与照顾者认知相关的社会经济因素。
我们对在这两个儿科急诊科就诊的2126名儿童的研究表明，在89%（1901/2126）的病例中，照顾者的评估与专业分诊所确定的病情严重程度相符。在142例（7%，142/2126）病例中，照顾者对孩子病情严重程度的评分高于护士的分诊；而在83例（4%，83/2126）病例中，照顾者的评分低于护士的分诊。在单变量分析中，我们发现家庭支付账单困难（20%对12%）和母亲教育程度低（19%对10%）与照顾者对孩子病情严重程度的评分高于护士分诊的比例较高相关。以发热为主诉与照顾者对孩子病情严重程度的评分低于护士分诊相关。
这项基于问卷的研究表明，在大多数情况下，照顾者对孩子病情严重程度的评估与护士分诊是一致的。我们的研究揭示了瑞士两个儿科急诊科中照顾者评估与专业分诊之间的关联，揭示了一些导致不一致的因素。这些因素很可能反映了健康素养低下的问题。医疗保健专业人员认识并解决影响照顾者评估的因素，以促进准确决策并改善儿科急诊护理结果，这一点很重要。
