title: Characteristics of tourist patients in an emergency department in a Mediterranean destination.
abstract: BACKGROUND
  Tourists are exposed to traditional health problems of the host country, such as trauma and the exacerbation of previously existing illnesses during their travels.
  
  
  OBJECTIVE
  The purpose of this study is to determine the clinical characteristics of tourist patients and any predictors of hospital admission.
  
  
  METHODS
  This retrospective observational study was carried out in the tertiary care hospital emergency department (ED) of a Mediterranean destination city, Antalya, Turkey. Hospital data from all tourist patients presenting or transferred to the ED between August 2003 and September 2004 were evaluated. Tourist patients were defined as all non-Turkish citizens.
  
  
  RESULTS
  A total of 961 tourist patients was studied, of whom 295 (31%) were admitted and 666 (69%) were discharged. Fifteen patients died in the hospital, 49 critically ill patients were transferred back to their home country, and 153 patients underwent a surgical intervention. The most common discharge diagnoses were trauma (405, 42%), nonspecific symptoms (106, 11%), and circulatory disorders (108, 11%). Admitted tourist patients were significantly older than those discharged; however, there were no differences in sex among the groups. Applying a logistic regression model, age, tachycardia, mode of arrival, and triage category were all found to be significant predictors of admission, but only the initial Glasgow Coma Scale was found to be a significant predictor of mortality. In total, 347 patients were from European Union (EU) countries, and 614 were from non-EU countries. A significant difference was found between the EU and non-EU patient groups according to age, mortality, admission rate, exposure to trauma, ED length of stay, hospital length of stay. Tourist patients from EU countries were older, had higher mortality, lesser trauma exposure, longer ED, and hospital length of stay.
  
  
  CONCLUSIONS
  EDs can be expected to manage tourist patients presenting for traumatic injuries and circulatory disorders. Clinical differences relating to patients' nationality might help in the development of targeted patient education and injury-prevention programs. Emergency physicians and the tourism industry should recognize the challenges of caring for this growing and aged patient population.
authors.affiliation: Department of Emergency Medicine, Akdeniz University Faculty of Medicine, Antalya, Turkey.
authors.forename: Oktay
authors.initials: O
authors.lastname: Eray
authors.forename: Mutlu
authors.initials: M
authors.lastname: Kartal
authors.forename: Neal
authors.initials: N
authors.lastname: Sikka
authors.forename: Erkan
authors.initials: E
authors.lastname: Goksu
authors.forename: Ozlem Erken
authors.initials: OE
authors.lastname: Yigit
authors.forename: Faruk
authors.initials: F
authors.lastname: Gungor
mesh_terms: D016638:Critical Illness; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006801:Humans; D038622:Internationality; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008499:Medical Records; D012189:Retrospective Studies; D014195:Travel / Q000706:statistics & numerical data*; D014421:Turkey