| 중증 소아 환자 병원 간 전원(轉院)에 영향을 미치는 요인에 관한 다수준 분석: 중증 응급 소아 환자를 대상으로 |
김지연1
, 양미연1
, 박은화1,2
, 이명화1
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1국립중앙의료원 중앙응급의료센터
2인제대학교 일반대학원 보건학과 |
| Multilevel analysis of factors affecting the interhospital transfer of high-acuity pediatric patients: a focus on severe pediatric emergency patients |
| Jiyeon Kim1
, Miyeon Yang1
, Eunhwa Park1,2
, Myounghwa Lee1
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1National Emergency Medical Center, National Medical Center, Seoul
2Department of Public Health Graduate School, Inje University, Busan |
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Received: August 1, 2024; Revised: September 15, 2024 Accepted: September 17, 2024. Published online: October 1, 2024. |
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| ABSTRACT |
Purpose:
The authors aimed to identify the factors affecting interhospital transfer (“transfer”) of severe pediatric patients who visited to an emergency department (ED).
Methods:
Using the Korean National ED Information System, we analyzed high-acuity patients aged 18 years or younger who visited EDs of local or regional emergency centers nationwide. The high acuity was defined as a Korean Triage and Acuity Scale 1-2. To investigate the factors associated with transfer, a multilevel modeling was selected, examining independent variables at both individual- and hospital-levels with transfer as a dependent variable.
Results:
A model consisting of variables at individual- and hospital-levels showed the factors as follows: mode of arrival(self-transport: odds ratio, 0.48 [95% confidence interval, 0.38-0.61]; other ambulances: 0.41 [0.24-0.71]; compared with firehouse ambulance), visit at 18:00-07:59 (0.75 [0.64-0.88]), intentional injury (1.59 [1.03-2.47]; compared with non-injury), decreased level of consciousness (drowsy: 1.94 [1.33-2.84]; stupor: 4.08 [2.99-5.57]; coma: 1.81 [1.26-2.60]; compared with alert), severe illness diagnosis (1.49 [1.12-1.98]), the number of all beds in EDs (1.02 [1.01-1.04]), and acceptance for treatment (0.92 [0.87-0.98]; with increment of 1%).
Conclusion:
This study confirms that both individual-level and hospital-level factors affect the transfer risk of severe pediatric patients in EDs. The study suggests the needs for direct transportation to specialized pediatric treatment facilities, and concentrated support for the pediatric emergency medical centers and pediatric trauma centers. |
| Key Words:
Child; Emergency Service, Hospital; Multilevel Analysis; Patient Acuity; Patient Transfer |
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