院间转诊患儿转诊原因及影响因素

Reasons and influential factors behind inter -hospital transfer of pediatric patients

目的了解院间转诊患儿选择转诊的原因，分析影响重症患儿或其监护人选择转诊原因（主彬客观）的影响因素。方法2012年8月1日至2013年5月31日院间转诊的602例重症患儿为研究对象，采用转诊调查量表收集患儿人口学特征、转诊原因、疾病类型和严重程度等资料，应用SAS9．2软件对所有资料进行频数分析、矿检验、多因素Logistic回归分析。结果47．17％（284／602例）院间转诊患儿由于主观原因转诊。不同年龄段患儿因主形客观转诊原因转诊的比例存在差异（x^2=81．10，P〈0．001）。入住重症监护室因主观原因转诊的比例（43．67％）低于普通儿科病房（57．21％），差异有统计学意义（x^2=23．47，P〈0．001）。非三级医院因主观原因选择转诊的比例（40．08％）低于三级医院（52．65％），差异有统计学意义（x^2=9．38，P=0．002）。危重型患儿因客观原因选择转诊比例（39．44％）高于非危重型（65．91％），差异有统计学意义（x^2=35．02，P〈0．001）。经多因素Logistic回归分析，转出医院级别、转出科室和疾病严重程度是影响家属主观选择转诊的危险因素（P〈0．05）。结论47．17％的院间转诊患儿因主观原因选择转诊，转出医院级别、转出科室和疾病严重程度是影响家属主观选择转诊的危险因素。

Objective To explore the reasons for inter- hospital transport and identify influential factors and objective or subjective reasons behind pediatric patients or their guardians. Methods Six hundred and two inter - hospital transportations of pediatric patients were recruited in the study from 1^st August 2012 to 31^st May 2013. The information on demographic characteristics,the reasons for inter -hospital transfer,the category of disease and the severity of illness were collected. Frequency description, chi - square test and non - conditional Logistics regression analysis were applied to analyze the data by using SAS 9.2. Results There were 47.17% （284/602 cases） pediatric patients transletted due to subjective reasons. The proportion of inter - hospital transfers was significantly different as a result of objective or subjective reasons in the different age categories （X2 = 81.10 ,P 〈 0.001 ）. The percentage of inter - hospital transters in pediatric/neonatal intensive care unit （43.67%） was lower than pediatric ward （57.21%）as a result of subjective reasons from referring hospitals （x^22 = 23.47, P 〈 0. 001 ）. The proportion of inter - hospitals transfers from non -tertiary hospitals （40.08%） was lower than that from tertiary hospitals （52.65%） as a result of subjective rea- sons,and the difference was statistically significant （x^22 = 9.38, P = 0. 002） ;39.44% critically ill pediatric patients were transferred,whereas 65.91% noncritically ill pediatric patients were transferred due to subjective reasons, and there was statistical significance（x^2 = 35.02,P 〈 0. 001 ）. The level of referring hospital, the referring department and the severity of illness were influence factors for inter - hospital transfers as a result of subjective reasons through multi- variate Logistic regression analysis （P 〈 0.05 ）. Conclusions Nearly half （47.17%） of pediatric patients were transferred because of objective reasons from referring hospitals. The level of referring hospital, the referring department and the severity of illness were influence factors for inter - hospital transfers as a result of subjective reasons.