The epidemiology of emergency medical services use by children: an analysis of the National Hospital Ambulatory Medical Care Survey.
The epidemiology of emergency medical services use by children: an analysis of the National Hospital Ambulatory Medical Care Survey.
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DOI：
10.1080/10903120802100167
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发表时间：
2008-07
影响因子：
2.4
通讯作者：
Friedman B
中科院分区：
文献类型：
--
作者：
Shah MN;Cushman JT;Davis CO;Bazarian JJ;Auinger P;Friedman B
缺乏具有全国代表性的数据来描述使用急救医疗服务的儿科患者以及与儿童使用急救医疗服务相关的因素。这项研究描述了患者通过EMS到达的儿科急诊科(ED)就诊的特征，并使用具有全国代表性的数据库确定了与这些就诊相关的因素。对1997-2000年全国医院非卧床医疗护理调查的ED部分进行了二次分析。因变量是到达急诊室的方式(EMS与非EMS)，自变量分为四个领域：人口统计、临床、系统和服务特征。采用双因素分析和多因素Logistic回归分析。在1997至2000年间，19岁儿童到急症室就诊的人次为1.109亿人次。在此期间，儿科患者占急诊就诊总数的27.3%，其中790万(7.1%)患者通过EMS到达。儿科患者占所有EMS运输的13%。儿童对环境管理系统的年使用率为每千人26人，而成人人口为每千人66人(p<；0.001)。由EMS运送的儿童中有16%被送往医院。62%的通过急救到达急诊室的儿科患者是由于受伤或中毒而被运送的。在最终的多变量模型中，与EMS的到来显著相关的特征包括人口统计(年龄、非裔美国人种族、城市居住)、临床(需要更直接的护理、与某些诊断相关的疾病)和服务(更多诊断服务)变量。由急救中心运送的儿科病人较以其他方式抵达急症室的病人更容易受伤和中毒，并有较高视力的疾病。儿科EMS使用的流行病学可能具有重要的操作、培训和公共卫生影响，需要进一步研究。
There is an absence of nationally representative data describing pediatric patients who use emergency medical services (EMS) and the factors associated with EMS use by children. This study characterizes pediatric emergency department (ED) visits for which the patient arrived by EMS and identifies factors associated with those visits using a nationally representative database. A secondary analysis of the ED component of the 1997–2000 National Hospital Ambulatory Medical Care Survey was performed. The dependent variable was the mode of arrival to the ED (EMS vs. not EMS), and independent variables were grouped into four domains: demographic, clinical, system, and service characteristics. Bivariate analyses and multivariate logistic regression analyses were conducted. There were 110.9 million ED visits by children aged <19 years between 1997 and 2000. Pediatric patients constituted 27.3% of all ED visits during this time, and 7.9 million (7.1%) of these patients arrived via EMS. Pediatric patients represented 13% of all EMS transports. The annual EMS utilization rate by children was 26 per 1,000, compared with 66 per 1,000 in the adult population (p < 0.001). Sixteen percent of children transported by EMS were admitted to the hospital. Sixty-two percent of pediatric patients arriving at the ED by EMS were transported as a result of injury or poisoning. Characteristics significantly associated with arrival by EMS in the final multivariate model included demographic (age, African American race, urban residence), clinical (need for greater immediacy of care, illnesses associated with certain diagnoses), and service (greater number of diagnostic services) variables. Pediatric patients transported by EMS are more likely to have injuries and poisoning, and have higher-acuity illness than those arriving at the ED by other means. The epidemiology of pediatric EMS use may have important operational, training, and public health implications and requires further study.