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계획되지 않은 소아응급실 재방문: 환자의 임상적 특성과 응급실 과밀화와의 관련성
장동현,김도균,곽영호,정재윤,서동범,장익완,정재현,서혜향,김주원,추지혜 대한응급의학회 2014 대한응급의학회지 Vol.25 No.5
Purpose: Revisit to the pediatric emergency department(ED) in the short-term period may be due to inadequateevaluation during the previous visit, which may indicate aproblem with quality in emergency care. The aims of thisstudy are to analyze the characteristics of patients whorevisited the pediatric ED within 48 hours after dischargeand to evaluate the relation between overcrowding andrevisit rates. Methods: Retrospectively, we reviewed the charts ofpatients who returned within 48 hours after visiting a PEDduring a one-year period between June 1st, 2011 andDecember 31st, 2011. We determined the rate of return visitsand review the characteristics of patients, emergency severityindex (ESI) level at visits, cause of revisit, diagnosis, andcrowding degree of the pediatric ED at the patient’s first visit. Results: A total of 16,688 patients visited the pediatric EDand 13,716 patients were discharged from the PED duringthe period. Of these discharged patients, 534 patients revisitedinevitably within 48 hours. The most common cause ofrevisit was relapse or worsened symptoms (70.0%). Therewas no significant difference in sex, severity of patient, andcrowding degree of the pediatric ED at the first visit, however,patients who revisited were younger than those who didnot (p=0.005). The ESI level at the return visit was significantlyhigher irrespective of admission after revisit(p<0.001). In diagnosis grouping, patients with gastrointestinaldiseases, respiratory diseases, and neoplastic diseasesshowed a higher rate of revisit. Conclusion: Approximately 4% of our pediatric ED visitswere for children returning within 48 hours. Patients whorevisited were younger and patients with gastrointestinal diseases,neoplastic diseases, and respiratory diseases weremore likely to revisit. Careful explanation of the possibility ofworsened symptoms is necessary for these patients.