從青少年健康觀點探討台灣10–17歲族群兒科急診健康需求之預測因子

Abstract

背景與目標：青少年健康保健是近來政府衛生單位積極推動的項目之一，目前著重的部分主要以門診及校園活動為優先。過去研究指出，至急診就醫的青少年，症狀與臨床表現相較於成人亦較為多元，故評估上也相對有較高之困難度。本研究欲了解急診就醫初始症狀與可能之隱藏性疾病之關係及其嚴重性，進而評估與青少年行為表現之相關因子，並檢視可能影響青少年就醫實際嚴重程度的相關因子。 方法：本研究利用次級資料，並納入人口學特性以及就診時段作為控制變項，了解變項之間與是否有急診醫療需求的關係及影響。納入2009/07–2014/07期間符合10–17歲青少年族群年齡層之病患急診就診資料。根據文獻回顧及研究設計，將所得的資料執行描述性統計、卡方檢定及多變項羅吉斯回歸，評估各項變項與主訴對於是否需要急診醫療需求的影響。本研究採用IBM SPSS 22.0版本進行資料分析。 結果：在本研究中，共有2,508位青少年(14.8%)具有相對嚴重的四項急診處置。多變項羅吉斯回歸之結果顯示，具下列幾項特質之青少年，可能會有四項較嚴重急診情況之一：年齡在16–17歲者(AOR=1.18)、檢傷分類較為嚴重者(Levels 1–3: AOR=1.68–2.15)、到訪急診時間為白天(08:00–15:59)者(AOR=1.14)、有一個以上不穩定之生命徵象者(AOR=1.34–1.64)，以及昏迷指數低於12者(AOR=5.28–14.34)；此外，如表現的主訴與內分泌或免疫性相關疾病(AOR=24.35)或中毒情形(AOR=19.30)有關者，也具有較高之風險。而男、女性青少年皆具有高風險的主訴為心理相關疾病(AOR=2.60、2.39)、神經性相關疾病(除頭痛外)(AOR=2.77、1.59)及腸胃道不適相關疾病(AOR=1.50–1.72、1.36–1.84)。 結論：青少年在高風險的健康狀況下也有著不同於大人的臨床表現。當青少年有心理相關疾病=、神經性相關疾病(除頭痛外)及腸胃道不適相關疾病的疾患等相關主訴時，臨床醫療工作者更應多加注意其健康狀態。因此青少年的急診需求預測因子對於臨床醫療工作的執行或者醫療品質的維護，無論是在急診或者是對於學校護理師或老師都是十分重要的。

Background and Objectives: Improving adolescent health is one of the most important tasks in the 21st century. Adolescents’ clinical presentations in the emergency room (ER) are much more multi-faceted than those of adults and carry significant clinical implications. However, little is known about the individual characteristics and clinical manifestations that may predict severe outcomes among ER-visiting adolescents. This study aimed to identify the factors that affect the acuity of ER visits among adolescents among male or female. Understanding the risk indicators may be helpful for alerting schoolteachers, clinicians, and pediatric ER doctors to recognize adolescents with poor prognoses. Methods: In this study, we analyzed data derived from 16,910 pediatric ER visits for non-traumatic disease at a teaching hospital in northern Taiwan between July 2009 and July 2014. The patients were adolescents aged 10–17 years. Four severe outcomes (e.g., death, admission to intensive care unit, etc.) were documented and used as measures of the patients’ need for emergency services. Descriptive statistics with χ2 tests and multivariate logistic regression were used for the analysis. Results: A total of 2,508 adolescents (14.8%) in this study experienced one of the four severe outcomes. In the multivariate model, the following characteristics were found to be significantly associated with any of the four severe outcomes: ages 16–17 years [adjusted odds ratio (AOR) = 1.18], triage levels 1–3 (AOR = 1.68–2.15), visiting the ER at times other than between 08:00 and 15:59 (AOR = 1.14), having more than one unstable vital sign (AOR = 1.34–1.64), and scoring <12 on the Glasgow Coma Scale (AOR = 5.28–14.34). In particular, chief complaints pertaining to endocrine-related disorders (AOR = 24.35) and poisoning (AOR = 19.30) were associated with a significantly higher risk of severe outcomes. In addition, mental disorder (AOR=2.60 and 2.39), neurologic disease (except headache) (AOR=2.77 and 1.59), and diseases and symptoms of digestive systems (AOR=1.50–1.72 and 1.36–1.84) were also significantly related to higher severe outcomes in male and female adolescents, respectively. Conclusions: Adolescents with high-risk conditions have different clinical presentations. More medical attention should be paid to adolescents with chief complaints associated with mental disorders, diseases and symptoms of digestive systems, and neurologic diseases (except headaches). The predictors of the need for pediatric emergency services can be instrumental in clinical practice and quality assessment not only in the ER but also for other clinicians as well as school nurses and teachers.