紧急情况严重性指数版本4和儿童急诊室患者的分类
Dana R Sax1, E Margaret Warton2, Mamata V Kene1
1The Permanente Medical Group and Kaiser Permanente Division of Research, Pleasanton, California.
JAMA pediatrics
|August 12, 2024
概括
使用紧急严重性指数 (ESI) 的误导在儿科急诊室很常见. 这项研究发现了改善重症和低急性儿科患者分拣准确性的机会.
科学领域:
- 紧急医疗 紧急医疗
- 儿科护理 儿科护理
- 改善医疗保健质量 改善医疗保健质量
背景情况:
- 紧急严重性指数 (ESI) 在美国急诊室 (ED) 中被广泛使用,以预测患者的敏度和资源需求.
- 目前缺乏专门针对儿科患者的ESI准确性的全面评估.
研究的目的:
- 用紧急情况严重性指数 (ESI) 版本4来评估儿科急诊室访问中错误治疗的频率.
- 在儿科群体中识别与不足和过量选相关的患者和访问特征.
主要方法:
- 在2016年1月1日至2020年12月31日期间,使用21个凯泽永久北加州ED的数据进行了一项回顾性队列研究.
- 针对每个ESI级别的操作措施被用来将遭遇分类为未得到选,过度选或正确选.
- 数据包括超过100万次儿科ED访问,不包括缺失ESI,不完整的数据,转移和未被看过或违背医疗建议离开的患者.
主要成果:
- 正确的分类发生在34.1%的儿科ED访问中,而过量分类发生在58.5%和不足分类发生在7.4%.
- 较年长的儿童 (≥6岁),男性,非白人种族/族裔,并发症患者和乘救护车到达的患者中,选不足的情况更为普遍.
- 在所有儿科访问中,过量分拣比正确分拣更为常见.
结论:
- 错误选,无论是不足选还是过量选,是儿科急诊室ESI版本4的一个常见问题.
- 有一个显著的机会来增强儿科ED分拣系统,以改善重症儿童的识别和有效分配资源的低急性患者.
- 未来的研究应该评估ESI版本5的性能,该版本是在研究期间之后发布的.
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