[Demand of emergency pediatric surgery. Study of inappropriate utilization].
BACKGROUND
Several studies have demonstrated that, between 30-60% of the cases, the urgent attention demand is considered inappropriate. This situation causes an increase in the sanitary costs and supposes for the patient a partial medical care. In the area of the Pediatric Surgery we have not found any work accomplished to such effect.


OBJECTIVE



METHODS
Transverse observational study.


METHODS
Emergency Service of a University Hospital.


METHODS
a sample random (alpha: 0.05; precision: 0.05) of the patients attended during 1998.


METHODS
Dependent: appropriateness. Independent: age, gender, proximity, diagnostic, studies of the parents, previous assistance, if attends by own initiative and motives that induce to demand. It was considered hospital emergency, continuing the criteria of the WHO, when it is considered vital emergency or when there is using of therapeutic or diagnostic means nor available in an primary level of health care. The statistic treatment consisted of a relative frequencies analysis, test x2 and t Student.


RESULTS
Of 2,226 cases attended in emergency service, they have 441 reviewed (age: 5.54 years; 63% male). The most frequent diagnoses have been: injuries and small traumatisms (39.7%), abdominal pain (22.2%), burns (3.6%), appendicitis (3.2%) and hernias (3.2%); 86.2% attended by own initiative. The proximity (19.9%), the alarm by the symptoms (13.1%) and the ignorance of the existence of other level of health care (10%) have been the causes by the parents for attention demand. The 63.9% of the visits were considered inappropriate. It has been found relationship between inappropriate use and age (p < 0.02), proximity (p < 0.003), to attend by own initiative (p < 0.001), and expectation of the parents (p < 0.02). It does not exist relationship to the gender or the studies level of the parents.


CONCLUSIONS
These data suggest that in the Emergency Services exists a high appropriateness. The accessibility, the availability of means, the rapidity of the attention and who takes the decision of attending are variable associated to the appropriateness.
Jiménez Alvarez
C
C
Hospital Universitario Virgen de las Nieves, Granada.
Alaminos Mingorance
M
M
Ruiz Montes
A M
AM
Morales Torres
J L
JL
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D013030:Spain; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D014600:Utilization Review