摘要目的 利用儿童5级预检分诊系统分析就诊患儿相关数据,旨在提高儿科急诊工作效率及危重患儿救治率.方法 回顾性观察性研究.参照国内外预检分诊系统,并根据实际情况,制订了儿科急诊5级预检分诊标准与流程.对2015年1月至2017年12月厦门大学附属第一医院儿科急诊科患儿进行研究,对患儿年龄、性别、疾病分布情况、各级患儿就诊等候时间、去向等进行分析.结果 本研究共纳入375 985例患儿,其中男225 308例(59.9%),女150 677例(40.1%).危重、紧急患儿(Ⅰ、Ⅱ、Ⅲ级)比例逐年增加,2015年为4 719例(3.7%),2016年为12 209例(10.2%),2017年为16 188例(12.7%).非紧急患儿中的Ⅴ级患儿比例逐年下降,2015年为98 213例(76.8%),2016年为75 210例(62.6%),2017年为78 857例(61.7%).Ⅰ、Ⅱ级患儿(1 855例, 0.5%)均能及时就诊;评估为Ⅲ级或Ⅳ级的患儿中有119 738例(98.3 %)能在规定的时间内就诊,而有2 112例(1.7%)未能及时就诊.评估为Ⅲ级的患儿等待时间逐年缩短,等候时间延长率逐年下降,2015年为10.71 min(延长率为2.2%),2016年为8.86 min(延长率为1.5%),2017年为8.81 min(延长率为1.5%).Ⅲ级的平均等候时间为9.09 min,Ⅳ级为17.7 min,Ⅴ级为55.76 min.危重、紧急、急诊患儿占急诊转儿童重症监护室(PICU)患儿比例增加,2015年为175例(36.2%),2016年为350例(62.8%),2017年为374例(66.2%).疾病分布统计显示呼吸道疾病275 460例(73.3%)、消化道疾病59 333例(15.8%) 、传染病11 487例(3.1%)、神经系统疾病6 230例(1.7%).结论 儿科急诊预检分诊系统制定并运行后,就诊患儿中危重症比例增加、候诊时间缩短,为早期识别危重症患儿、提高救治率及优化急诊资源起到至关重要作用.

abstractsObjective To assess the effectiveness in optimizing resources and shortening critical children's waiting time in pediatric emergency department (PED) with five-level pediatric emergency triage system (PETS). Methods This retrospective study was conducted in the First Affiliated Hospital of Xiamen University after PETS was applied. The data of patients who visited the pediatric emergency department from January 2015 to December 2017 were collected and analyzed, including age, sex, diseases, visiting time, triage rate and destination. Results A total of 375 985 patients were included, among whom males were 225 308 (59.9%) and females were 150 677 (40.1%), all younger than 14 years of age. The number of critical cases (levelⅠ, levelⅡand levelⅢ) was increased from 4 719 (3.7%) in 2015, 12 209 (10.2%) in 2016 to 16 188 (12.7%) in 2017. The number of non-critical patients (level Ⅴ) decreased year by year, as from 98 213 (76.8%) in 2015 to 75 210 (62.6%) in 2016 and 78 857 (61.7%) in 2017. The patients who classified as levelⅠor levelⅡaccording to the PETS were seen immediately by physician (n=1855, 0.5%). Overall, 119 738 patients (98.3%) who were classified as levelⅢor levelⅣcould be seen by physician in a timely manner according to triage guidelines, while 2 112 patients (1.7%) could not. The mean waiting time was 9.09 min in level Ⅲ, 17.7 min in level Ⅳ, and 55.76 min in level Ⅴ patients, respectively. The critical cases admitted to the intensive care units were 175 (36.2%) in 2015, 350 (62.8%) in 2016 and 374 (66.2%) in 2017. The etiologies were respiratory diseases (73.3%), gastrointestinal diseases (15.8%) and infectious diseases (3.1%). Conclusion The application of PETS could optimize emergency resources and shorten the waiting time of critically ill children.