Frequent users in paediatric emergency departments. Who are they? Why do they consult?

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• 作者：Arí ; stides Rivas Garcí ; a^a ; ^{arisrivas@hotmail.com} ; Gema Manrique Martí ; n^a ; Laura Butragueñ ; o Laiseca^a ; Sofí ; a Mesa Garcí ; a^b ; Alfonso Campos Segura^c ; Vanessa Ferná ; ndez Iglesia^d ; Rub&eacute ; n Moreno Sá ; nchez^e ; Juan Mariano Aguilar Mulet^f ; on behalf of the Grupo de Trabajo del Paciente Fidelizado Pediá ; trico de la Comunidad de Madrid¹
• 关键词：Frequent user ; Paediatric emergency department ; Re-consultation
• 刊名：Anales de Pediatría (English Edition)
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：86
• 期：2
• 页码：67-75
• 全文大小：642 K
• 卷排序：86

文摘

To determine the prevalence of frequent Paediatric Emergency Departments users and to analyse their characteristics, comparing initial consultations and re-consultations.MethodsThis is a multicentre retrospective cohort study of all patients who made 10 or more visits to the Paediatric Emergency Departments of 5 public hospitals between 1 January 2013 and 31 December 2013. An analysis was performed on the patient demographics and clinical data of the first consultation and consecutive re-consultations.ResultsFrequent users represented 0.60% (95% CI: 0.56–0.64%) of Emergency Department users, and accounted for 3.93% (95% CI: 3.47–4.39%) of all visits. The most numerous age group consisted of children under 2 years old (66.6%). Frequent users distributed their visits throughout the year (62.3%; P < .001), and did not have a chronic condition associated with their chief complaint (86.4%; P < .001). They were usually classified as non-urgent or less urgent in triage (3186 vs. 1812; P < .001), and often did not require any intervention, such as complementary tests (79.4%) or observation/treatment (60%). Admission rate was similar to the general paediatric population (5.3%). Re-consultations represented 27% of these patient visits, mostly related to persistence of symptoms (56.3%), with 13.8% of them consulting their Primary Care physician before seeking successive medical attention in the Paediatric Emergency Department.ConclusionsPaediatric frequent users often ask for medical care in the Emergency Department before consulting their Primary Care physician. They present with less urgent processes and do not systematically need diagnostic or therapeutic interventions. Re-consultations make up a significant number of visits, in which more interventions are done and more children are admitted.