Sansa Pérez L, Orús Escolá T, Juncosa Font S, Barredo Hernández M, Travería Casanova J
Pediatra, ABS Badia, Barcelona.
An Esp Pediatr. 1996 Feb;44(2):97-104.
It is well known the high attendance frequency of the hospital emergency services (HES). In order to know the reason and justification of this demand, the emergency visits to the reference HES from a paediatrician population of our Health Center are studied. The results of a questionnaire of 304 emergencies are analyzed and compared with the level of frequency of the children to the HES. The follow-up of the emergency in the health center is also assessed. 82% of the emergencies attend the HES by themselves and the main reason to justify this behaviour were (up to two arguments): the paediatrician schedule unfit their requirements (55.5%), the likelihood to perform complementary tests (42.3%), rather than the severity of the process of the child (28.3%). The lower is the mean of brothers and sisters and the social class of the father, the higher is the frequency to the HES. 4.5% of the emergencies ended inpatient, and in 33% a complementary tests was performed. The lesser complementary tests are conducted the higher is the frequency to the HES (p = 0.001). Bases on the medical assessment, the emergency is justified in 28.1% of the cases, but it raised up to 44.4% when social arguments are also considered by the doctor who attended the emergency. 50% observe the advised to follow up in the Health Center, accomplishing better those with higher frequency. We consider that social and psychological elements of the children family, and the need to resolve the health problem as soon as possible, are two considerations more important than the severity of the process in the genesis of over-utilization of the HES.
医院急诊服务（HES）的高就诊频率是众所周知的。为了了解这种需求的原因和合理性，我们对来自我们健康中心儿科人群到参考HES的急诊就诊情况进行了研究。分析了304例急诊调查问卷的结果，并与儿童到HES的就诊频率水平进行了比较。还评估了健康中心对急诊的随访情况。82%的急诊是自行前往HES的，这种行为的主要理由（最多两个理由）是：儿科医生的日程安排不符合他们的要求（55.5%），进行补充检查的可能性（42.3%），而不是儿童病情过程的严重程度（28.3%）。兄弟姐妹的平均数和父亲的社会阶层越低，到HES的就诊频率越高。4.5%的急诊最终住院，33%进行了补充检查。进行的补充检查越少，到HES的就诊频率越高（p = 0.001）。根据医学评估，28.1%的病例急诊是合理的，但当处理急诊的医生也考虑社会因素时，这一比例上升到44.4%。50%的人遵守了在健康中心随访的建议，就诊频率较高的人做得更好。我们认为，儿童家庭的社会和心理因素，以及尽快解决健康问题的需求，是HES过度使用成因中比病情严重程度更重要的两个因素。
