Differences in the consultation motives between referral and non-referral patients attending a Critical Care and Emergency Service at a general hospital

Márquez Cabeza JJ, Domínguez Quintero B, Méndez Sánchez J, Gómez Álvarez B, Toronjo Romero S, Del Río Morales E, Caballero García F

Objectives: To analyse the differences between the consultation

motives among patients attending a Critical Care and Emergency

Service at a general hospital by comparing paediatric referral

patients and those who were brought directly to the hospital.

Methods: Observational descriptive study. Patients of both genders with

an age range between 0 and 12 years were included who did not come

to the hospital because of traumatisms. Referral and non-referral patients

were further stratified according to the severity of their condition.

Results: The total study population comprised 411 patients (52.6% males)

with an average age of 3.10 years (95% CI 2.82-3.39). Only 24.6%

were referral cases, the remaining 75.4% having come or been brought

directly to the Service. The most frequent motives for consultation were

respiratory problems (30.7%), fever (25.3%) and gastrointestinal conditions

(22.6%). Among non-referral patients, the most frequent reasons

for coming to the Emergency Service were lack of access to an extrahospitalary

paediatrician (31.3%), considering that urgent attention was

required (23.8%) and wish for a second opinion (14%). Among the referral

patients, 45.5% required further complementary tests, 22.8% were

admitted for observation or treatment, and 31.7% were discharged directly;

the corresponding data for the non-referral patients were 92%,

3.9% and 66.9%, respectively (p = 0.0001). Among the non-referral patients,

93.5% were classed as “severity level 4”, versus only 80.2% of

the referral ones (p = 0.0001).

Conclusions: 1. The most frequent reason for seeking consultation at the

paediatrics area of a hospitalary Emergency Service was the nonavailability

of an extrahospitalary paediatrician. 2. The most frequent motives

of consultation were respiratory problems and fever. 3. Referral patients

significantly more often require complementary testing and admission,

and significantly more often evidence more severe conditions.

Caballero García F, Del Río Morales E, Domínguez Quintero B, Gómez Álvarez B, Márquez Cabeza JJ, Méndez Sánchez J, Toronjo Romero S