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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Referral to the emergency department by a primary care provider predicts severity of illness.
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Referral to the emergency department by a primary care provider predicts severity of illness.

机译：由初级保健提供者转诊至急诊部门可以预测疾病的严重程度。

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OBJECTIVE: The purpose of this study was to assess whether referral to a pediatric emergency department (PED) by a primary care provider was associated with greater severity of illness, as determined on the basis of clinical measures and increased resource utilization. METHODS: A retrospective study of data for 121 088 children who presented to a PED with abdominal pain, fever, or respiratory complaints during a 5-year period was performed. Demographic data, referral status, and proxy markers of illness severity were collected from the medical records and analyzed. RESULTS: A total of 26.3% of all patients seen in the PED presented with these 3 complaint categories. With adjustment for age, gender, race, and insurance class, referred patients were significantly more likely to have high triage acuity designations, higher rates of very abnormal vital signs, and higher admission rates, compared with patients who were self-referred. Referred patients were more likely to undergo testing (laboratory or radiologic), to receive intravenous fluid therapy and pain medications, and to be assigned higher-severity discharge diagnoses, such as appendicitis, septic shock, or status asthmaticus. CONCLUSIONS: Referral by a primary care provider to a PED was significantly and independently associated with greater severity of illness and resource utilization. Referral status should be considered in algorithms used to triage cases for evaluation in the PED.
机译：目的：本研究旨在评估由初级保健提供者转诊至儿科急诊科（PED）是否与更大的疾病严重度相关联，这取决于临床措施和资源利用的增加。方法：进行了一项回顾性研究，研究了在5年内出现PED的腹痛，发烧或呼吸系统不适的121 088名儿童的数据。从病历中收集人口统计数据，转诊状态和疾病严重程度的代用指标并进行分析。结果：在PED中看到的所有患者中，共有26.3％出现了这3个投诉类别。通过调整年龄，性别，种族和保险级别，与自荐患者相比，转诊患者明显更有可能具有较高的分流敏锐度，较高的异常生命体征率和较高的入院率。被转诊的患者更有可能接受检查（实验室或放射学），接受静脉输液治疗和止痛药，并被分配为更高严重度的出院诊断，例如阑尾炎，败血性休克或哮喘状态。结论：初级保健提供者转诊PED与疾病严重程度和资源利用的严重性和独立性显着相关。在用于对案例进行分类以在PED中进行评估的算法中，应考虑转诊状态。

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