Ziv A, Boulet J R, Slap G B
Craig-Dalsimer Program in Adolescent Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, USA.
Pediatrics. 1998 Jun;101(6):987-94. doi: 10.1542/peds.101.6.987.
Adolescents in the United States have been shown to underutilize primary care services and therefore may rely heavily on emergency service. Although several small studies have explored local emergency services for youth, there are no published reports of adolescent utilization of emergency services on a national scale. Furthermore, emergency services data have not been aggregated according to the age subgroups used by the current guidelines for adolescent care.
To explore the utilization of emergency departments in the United States by early (11 to 14 years), middle (15 to 17 years), and late (18 to 21 years) adolescent subgroups.
Secondary analysis of the emergency department component of the 1994 National Hospital Ambulatory Medical Care Survey.
Nationally representative sample of 418 emergency departments in the United States.
Approximately 26,547 visits by patients of all ages, representing 93.4 million total visits in 1994 and 14.8 million adolescent visits.
Number of visits, health insurance, reasons for visits, urgency of visits, resulting diagnoses, and hospitalization rates.
Adolescents accounted for 15.4% of the population and 15.8% of emergency department visits in 1994. Late adolescents were overrepresented in emergency department visits relative to their population proportion (6.8% of visits, 5.3% of population), whereas early adolescents were underrepresented (4.6% of visits, 5.9% of population). Lack of health insurance was more common among 11- to 21-year-olds (26.2%) than either children (13.6%) or adults (22.7%). By ages 18 to 21 years, 40.5% of male visits and 27.6% of female visits were uninsured. Injury-related visits were more common among adolescents (28.6%) than either children (23.1%) or adults (18.2%). Injury was the leading reason for visits among all adolescent age-sex subgroups (36.6% to 42.0% of male visits and 14.1% to 27.2% of female visits) except females aged 18 to 21 years for whom digestive reasons ranked first (18.8%). Injury was the leading diagnosis for all adolescent age-sex subgroups, with peaks at early adolescence of 61.6% for males and 45.8% for females. Across all adolescent age-sex subgroups, 3.1% to 5.3% of visits resulted in hospitalization, and 41.0% to 52.5% of visits were urgent. These rates did not differ from those of children but were lower than those of adults.
Utilization of emergency departments increases and health insurance decreases during adolescence, suggesting that adolescents with inadequate health insurance may rely heavily on emergency departments for their health care needs. Most adolescent visits to emergency departments are not urgent and might be better treated through nonemergency, primary care sites.
研究表明，美国青少年对初级保健服务的利用率较低，因此可能严重依赖急诊服务。尽管有几项小型研究探讨了针对青少年的当地急诊服务，但尚无关于全国范围内青少年急诊服务利用率的公开报告。此外，急诊服务数据尚未按照当前青少年护理指南所使用的年龄亚组进行汇总。
探讨美国早期（11至14岁）、中期（15至17岁）和晚期（18至21岁）青少年亚组对急诊科的利用率。
对1994年全国医院门诊医疗调查的急诊科部分进行二次分析。
美国418个急诊科的全国代表性样本。
各年龄段患者约26,547次就诊，代表1994年总就诊次数9340万次以及青少年就诊次数1480万次。
就诊次数、医疗保险、就诊原因、就诊紧急程度、最终诊断以及住院率。
1994年，青少年占总人口的15.4%，占急诊科就诊人数的15.8%。相对于其人口比例，晚期青少年在急诊科就诊人数中占比过高（就诊人数的6.8%，人口的5.3%），而早期青少年占比过低（就诊人数的4.6%，人口的5.9%）。11至21岁人群中缺乏医疗保险的情况比儿童（13.6%）或成年人（22.7%）更为普遍。到18至21岁时，男性就诊者中有40.5%未参保女性就诊者中有27.6%未参保。与损伤相关的就诊在青少年中（28.6%）比儿童（23.1%）或成年人（18.2%）更为常见。除18至21岁女性外，损伤是所有青少年年龄性别亚组就诊的主要原因（男性就诊的36.6%至42.0%，女性就诊的14.1%至27.2%），18至21岁女性就诊的主要原因是消化系统问题（18.8%）。损伤是所有青少年年龄性别亚组的主要诊断，在青春期早期达到峰值，男性为61.6%，女性为45.8%。在所有青少年年龄性别亚组中，3.1%至5.3%的就诊导致住院，41.0%至52.5%的就诊为紧急情况。这些比率与儿童的比率没有差异，但低于成年人的比率。
在青春期，急诊科利用率增加而医疗保险覆盖率下降，这表明医疗保险不足的青少年可能严重依赖急诊科来满足其医疗需求。大多数青少年到急诊科就诊并非紧急情况，通过非紧急的初级保健机构治疗可能会更好。
