Reference of Primary Health Care to the Pediatric Emergency Department at a Level II Hospital: What Reality?

Abstract

INTRODUCTION: Our objective was to characterize the situations referred to the emergency department by the primary health care as well as assess the pertinence of this referral.
METHODS: A study realized was observational, retrospective and included patients were younger than 18 years old referred to the emergency department by primary health care, over 2017. The referral was considered appropriate when complementary exams or therapeutics were performed, which were not available at the primary health care, as well as observation by other medical speciality but paediatrics, admission necessity or transfer to other hospital were needed.
RESULTS: A total of 406 emergency episodes were obtained. The most frequent diagnoses were respiratory disease (29.4%) and gastrointestinal disease (25.9%). A percentage of 65.3% of referrals were considered adequate and the most common pathologies were gastrointestinal and respiratory disease and trauma. The genitourinary (OR = 11.5) and infectious (OR = 3.49) pathologies were consistent on inadequate referral considering patients’ age. A match between referral’s reason and final diagnosis regarding gastrointestinal pathologies, otolaryngology pathologies and ophthalmic pathologies, as well as trauma (kappa > 0.7), was observed. The majority (92.2%) of the cases was discharged from the hospital.
CONCLUSION: The hospital’s adequate referral rate was similar to the one described in other studies. However, communication’s optimization between the primary health care units and the emergency department, as well as more professional training, are vital to improve this referral.