北京等15个城市脑卒中患者院前时间及影响因素研究

目的 研究北京等15个城市35家医院脑卒中患者到达医院前时间（院前时间）及其影响因素。方法 通过统一的问卷，对2002年6月30日至2003年4月30日发病一周内的2270例脑卒中患者进行调查。除一般资料外，按是否在脑卒中症状发生后6h内到达医院将患者分为两组，对影响脑卒中院前时间的因素进行单因素和多因素logistic回归分析。结果 （1）患者的平均年龄为64．8岁，男性占60．2％。缺血性脑卒中为78．8％，出血性脑卒中为21．2％。（2）发病后决定马上去医院的占27，8％。使用急救电话和急救车的比例为27．2％；约1／4患者知道脑卒中后需要马上去医院诊治和溶栓治疗；1／4的患者对脑卒中基本无认识，发病后不知道求救而盲目等待。（3）发病后≤6h到达医院的患者占57．5％；首次就诊地点是急诊室的为58．6％；发病后≤6h到达医院的缺血性脑卒中溶栓率为6．7％。（4）影响脑卒中患者院前时间的多因素分析显示：到达医院的方式、首次就诊的地点、发病地点到医院的距离、是否了解疾病的相关知识是影响患者≤6h到达医院的独立因素。结论 42．5％脑卒中患者不能在发病后6h内到达医院，其院前时间延误的主要原因是对脑卒中知识了解不够、使用急救电话／急救车少、患者转运距离超过20km等。加强公众对脑卒中知识的了解是提高患者6h内到达医院的重要因素。     

威海市急性脑梗死院前延迟的原因分析与对策

目的研究威海市区2家医院脑梗死患者到达医院前时间（院前延迟）的影响因素及对策。方法回顾性研究了进入医院急诊就诊的急性脑梗死病人的院前延迟影响因素，并制定相应对策。对所有资料分别采用KruskalWal—lis检验方法和logistic回归进行单变量和多变量分析。统计学软件采用SPSS12．0和SAS6．0。结果患者平均到达医院急诊时间为312min，27．27％于发病2h内到达医院急诊，42．08％于发病5h内到达医院急诊。单因素分析显示：女性、非独居、有医疗保险、首发症状为传统症状、病人能识别卒中症状、病人或救助者能认识脑梗死治疗紧迫性、由120救护车或110警车进行运送有利于及早到达医院急诊。多因素回归模型显示：影响及早到达医院急诊最重要因素是运送方式和首发症状，使用120救护车或110警车运送病人而非使用其他运送方式和卒中表现为传统症状能缩短入院时间。结论57．92％急性脑梗死患者不能在发病后5h内到达医院。为了缩短到达医院急诊时间，应加强对民众急性脑梗死知识的宣传教育；提高社区医生脑梗死诊治水平；进一步完善城镇基本医疗保险制度和新型农村合作医疗制度建设，扩大参保、参合率；重视敬老院、老年公寓建设，减少独居老年人比例。     

影响脑卒中患者入院延迟的相关因素调查研究

目的 探讨目前影响脑卒中患者人院延迟的相关因素.方法 对2008年4-9月确诊脑卒中住院患者179例进行问卷调查.根据发病至住院的时间将患者分为≤6h组(85例)和>6h组(94例),分析影响入院延迟的相关因素.结果 179例患者发病至住院的平均时间(26.2±0.1)h,中位时间为7.5 h.两组患者既往有心脏病和糖尿病病史、发病地点距医院较近、首发症状有抽搐或意识障碍、首诊地点为急诊室、选择急救120、就诊途中时间等因素比较差异有统计学意义(P<0.05).Logistic回归分析显示,发病地区远、门急诊处置时间长是影响入院延迟的主要因素.结论 目前脑卒中患者入院延迟现象严重,缺血性脑卒中溶栓率低.主要原因在于患者对脑卒中相关知识不了解,不能充分利用院前急救系统.     

急性中风患者延迟就诊原因分析

目的研究探讨急性中风患者院前延误就诊程度及其原因，对普及卫生保健常识、中风的预防治疗有一定意义。方法综合考虑诸如社会经济地位、在出现症状时运送的方式等。统计数据从医院获得，以问卷方式掌握如下问题：人口统计、自我报告危险因素、有关去医院情况。结论大约31．6％患者在发病3h后到达医院。大约1／3的患者因为他们等待症状消失而拖延了去医院，另外1／3的患者未及时就医是因为他们不知道及时就医的重要性。在利用救护车运送和到达医院用时之间有显著相关性，在中风的危险因素和就医拖延之间无显著相关性。结论这个研究结果可能对普及教育人们的卫生保健常识、中风的预防保健有一定意义。     

Place of death after stroke--United States, 1999-2002

Stroke is the third leading cause of death in the United States. Successful acute stroke intervention depends on early recognition of symptoms, prompt emergency transport, and rapid in-hospital treatment. However, approximately half of stroke decedents die before admission to the hospital. During 1990-1998, the proportion of stroke deaths that occurred in hospitals declined, and the proportion occurring before transport to hospitals increased. This report summarizes trends in the place of death among all stroke decedents, the proportion of stroke deaths occurring before emergency assistance arrives, and characteristics associated with place of death. Among 162,672 persons who died of stroke in 2002, 49.2% died pre-transport, 0.4% were dead on arrival (DOA), 3.3% died in emergency departments (EDs), and 47.0% died after admission to a hospital. Early patient and bystander recognition of stroke symptoms and timely action in calling for emergency assistance might reduce the number and proportion of stroke deaths. In addition, improving timely arrival of emergency care and appropriate treatment of stroke patients can reduce the proportion of pre-transport deaths and serious sequelae that lead to severe disabilities.     

Using a quality improvement process to create measurable improvement in care delivery for acute stroke

The introduction of thrombolytic therapy has revolutionized the management of acute ischemic stroke, and it has now been conclusively established that tissue plasminogen activator (t-PA) given within 4.5 hours of stroke onset both limits irreversible ischemic neuronal damage by establishing reperfusion of the penumbra and improves outcomes for patients who have undergone stroke. As a regional stroke centre, Hamilton Health Services (HHS) seeks to ensure it meets guidelines and readiness criteria in acute stroke care. This article discusses how HHS developed and used a quality improvement process to ensure all patients receive thrombosis therapy within 60 minutes of arrival at hospital.     

Concordance of stroke symptom onset time. The Second Delay in Accessing Stroke Healthcare (DASH II) Study

PURPOSE: This study examines the concordance between symptom onset obtained during an interview in the emergency department (ED) compared to that recorded in the medical record among patients with stroke-like symptoms and characterizes the frequency of missing symptom onset information in the medical record. METHODS: Interviews with patients presenting with signs and symptoms of acute stroke were completed in the ED of seven hospitals to determine symptom onset time. Symptom onset recorded in the medical record was abstracted after the patient was discharged. RESULTS: Among the patients who presented to the ED with stroke-like symptoms, 60.2% overall and 61.9% among stroke patients had a symptom onset date and time recorded in the medical record. The Pearson correlation of prehospital delay time, comparing symptom onset obtained by interview to that obtained by the medical record was 0.80 and among stroke patients was 0.91. Concordance of prehospital delay time for stroke within +/- 1 h between the interview and the medical record was 60.1%. For stroke patients, concordance was more likely for those who had higher functional status prior to the acute episode. CONCLUSIONS: Symptom onset time was often missing from the medical record. Standardized and systematic recording of delay time in the medical record could increase its utility as a clinical measure and as a research tool for acute stroke.     

Gender differences in knowledge of stroke in patients with atrial fibrillation

BACKGROUND: A limiting factor for immediate initiation of stroke therapy is delayed hospital arrival. We assessed general knowledge on and behavior during an acute stroke with particular emphasis on prehospital temporal delays and a focus on the high-risk group of patients with atrial fibrillation (AF). METHODS: As part of the Berlin Acute Stroke Study (BASS), we interviewed patients admitted to hospital with symptoms of stroke using a standardized questionnaire. Cardiac rhythm was assessed by ECG and Holter monitor. Data analysis included additional stratification for age and gender. RESULTS: Of a total of 558 patients (66.8 +/- 13.5 years; 45% female) diagnosed with TIA or stroke 28% interpreted their own symptoms correctly as due to stroke. Female patients reporting cardiac arrhythmias and having AF more often correctly interpreted their symptoms as stroke (P = 0.03), considered their symptoms urgent (P = 0.02), considered stroke a medical emergency (P < 0.05) and had shorter prehospital delay times (P = 0.001) compared to female patients not reporting cardiac arrhythmias. Male, younger (< 65 years) and older patient groups showed no such effect, respectively. CONCLUSION: Females who know to have AF demonstrate better knowledge of stroke symptoms compared to females unaware or without this risk factor. This better knowledge translates into more appropriate behavior during an acute stroke.     

Earlier treatment of acute myocardial infarction with administration of alteplase (rt-PA) before hospitalization

The gain in survival by thrombolytic therapy in patients with myocardial infarction is determined by the delay between coronary occlusion and reperfusion. The REPAIR study was designed to examine the feasibility and safety of prehospital thrombolysis with alteplase (rt-PA, Actilyse). Indications and contraindications are verified by general practitioner or ambulance nurse with a short questionnaire. A small portable ECG computer system is used to confirm the presence of a large evolving myocardial infarction 'on the spot'. Between June 1988 and May 1990, 150 patients were treated by the ambulance service. Therapy could be initiated within an average of 91 (+/- 40) minutes (sd) after the onset of symptoms, and within 23 (+/- 9) minutes after ambulance arrival. Three patients were defibrillated during transportation, in one of these therapy had to be discontinued because of cardiac massage. No other complications were observed. Five patients (3%) died after arrival in the hospital. The time gained by prehospital treatment averaged 47 (+/- 2) minutes in comparison with 220 patients who received thrombolytic therapy after hospital admission. The procedure allows rapid and safe initiation of thrombolytic therapy in selected patients, even in the absence of a physician.     

Prehospital thrombolysis--calculated health benefit for catchment population of one hospital

The health benefit of thrombolysis in acute myocardial infarction is greatest when patients are treated soon after onset of symptoms. One approach to reducing treatment delay is to give thrombolysis before the patient reaches hospital. When an ambulance trust proposed a prehospital thrombolysis service, local commissioners requested an estimate of its possible health impact. Clinical audit and ambulance trust data were obtained for 165 patients who received thrombolysis for acute myocardial infarction in the coronary care unit of a local hospital in one year. This information was then used to estimate the health impact of prehospital thrombolysis in the local population in a mathematical model derived from the results of trials comparing prehospital and hospital thrombolysis. The best predicted local health benefit from the proposed prehospital thrombolysis service is that, if 45 minutes can be cut off the call-to-needle time, 61 cases of acute myocardial infarction need to be treated to save one additional life at 35 days. By use of published research data, the health benefits of prehospital thrombolysis can be estimated for a local population. Variables in the treatment population and ambulance service will influence the size of the health benefit that can be achieved.     

Modifiable determinants of delayed hospital admission following a cerebrovascular accident

OBJECTIVE: To identify the modifiable determinants of delayed hospital admission of stroke patients. DESIGN: Multicentre observational study. METHOD: In the period from 1 October 1998 to 31 May 1999, before thrombolysis was an accepted treatment for ischaemic stroke in the Netherlands, we interviewed 252 consecutively admitted patients with stroke upon admission. The patients were asked to describe their symptoms and personal reaction to the stroke event in everyday language. The study was carried out in 14 regional hospitals and one university hospital in the Netherlands. The determinants of delay were calculated by means of multiple linear regression analysis. RESULTS: A total of 252 patients took part in the study: 136 men and 116 women, of whom 130 (52%) were 75 years of age or older. The median time from onset of symptoms to calling in any professional assistance was 60 minutes. The median time from onset of symptoms to arrival at the hospital was 5 hours and 10 minutes. One-third (n = 87; 34%) of the patients reached the hospital within 2.5 hours. Nearly half of the patients (46%) recognised their symptoms as a stroke. Patients who had not recognised their symptoms as a stroke (54%) and patients who had waited until their symptoms had worsened (20%) waited longer before calling in professional assistance than those who did not. Hospital admission was delayed in patients who had waited until their symptoms had worsened, and in those who had first called a family physician (87%). On the other hand, a more rapid admission was achieved in case of referral by the family physician by telephone and also after transportation by ambulance (77%). CONCLUSION: The modifiable determinants of delayed calling for professional help by stroke patients were the fact that they did not recognise the symptoms as a stroke, and the circumstance that they waited until the symptoms would disappear or become worse. This latter circumstance, referral by the family physician by telephone and transportation by ambulance, were modifiable determinants of delayed hospital admission.     

Acute Stroke Care at Rural Hospitals in Idaho: Challenges in Expediting Stroke Care

CONTEXT: Thrombolytics are currently the most effective treatment for stroke. However, the National Institute for Neurological Disorders and Stroke criteria for initiation of thrombolytic therapy, most notably the 3-hour time limit from symptom onset, have proven challenging for many rural hospitals to achieve. PURPOSE: To provide a snapshot of stroke care at rural hospitals in Idaho and to investigate the experiences of these hospitals in expediting stroke care. METHODS: Using a standard questionnaire, a telephone survey of hospital staff at 21 rural hospitals in Idaho was performed. The survey focused on acute stroke care practices and strategies to expedite stroke care. FINDINGS: The median number of stroke patients treated per year was 23.3. Patient delays were reported by 77.8% of hospitals, transport delays by 66.7%, in-hospital delays by 61.1%, equipment delays by 22.2%, and ancillary services delays by 61.1%. Approximately 67% of hospitals had implemented a clinical pathway for stroke and 80.0% had provided staff with stroke-specific training. No hospitals surveyed had a designated stroke team, and only 33.3% reported engaging in quality improvement efforts to expedite stroke care. Thrombolytics (tPA) were available and indicated for stroke at 55.6% of the hospitals surveyed. CONCLUSIONS: Rural hospitals in Idaho face many difficult challenges as they endeavor to meet the 3-hour deadline for thrombolytic therapy, including limited resources and experience in acute stroke care, and many different types of prehospital and in-hospital delays.     

Thrombolytic therapy in patients with acute brain infarction: favorable preliminary results in Maastricht

OBJECTIVE: To assess the feasibility of acute thrombolysis for ischaemic stroke in clinical practice. DESIGN: Prospective. METHOD: On July 1st, 1998 thrombolytic therapy for ischaemic stroke was introduced in the University Hospital Maastricht, the Netherlands. All patients admitted with ischaemic stroke were prospectively registered during the first year. Of all patients with ischaemic stroke, it was determined how many were potentially eligible for thrombolysis within 3 hours of stroke symptom onset, and how many of these patients were actually treated with thrombolysis. Furthermore, the reasons for exclusion from thrombolytic therapy were assessed. Several baseline and clinical patient characteristics were noted. RESULTS: During the first year 18 ischaemic stroke patients were treated with thrombolysis within 3 hours of stroke onset. These 18 patients constituted 7% of all 256 ischaemic stroke patients and 18% of the potentially eligible patients who arrived in the hospital within 3 hours. More than 40% of the ischaemic stroke patients were not eligible for thrombolysis due to late arrival in the hospital. There were no major complications in the 18 treated patients: 3 patients developed an asymptomatic haemorrhagic transformation of the infarct. CONCLUSION: Acute thrombolysis for ischaemic stroke within 3 hours from stroke onset is feasible, and can under specific conditions be applied in clinical practice. Only 7% of all ischaemic stroke patients underwent thrombolysis. This percentage of patients could be increased by an earlier presentation of patients to the hospital.     

Risk of Rehospitalization or Emergency Department Visit is Significantly Higher for Patients who Receive Their First Home Health Care Nursing Visit Later than 2 Days After Hospital Discharge

ObjectivesThis study explored the association between the timing of the first home health care nursing visits (start-of-care visit) and 30-day rehospitalization or emergency department (ED) visits among patients discharged from hospitals.DesignOur cross-sectional study used data from 1 large, urban home health care agency in the northeastern United States.Setting/ParticipantsWe analyzed data for 49,141 home health care episodes pertaining to 45,390 unique patients who were admitted to the agency following hospital discharge during 2019.MethodsWe conducted multivariate logistic regression analyses to examine the association between start-of-care delays and 30-day hospitalizations and ED visits, adjusting for patients’ age, race/ethnicity, gender, insurance type, and clinical and functional status. We defined delays in start-of-care as a first nursing home health care visit that occurred more than 2 full days after the hospital discharge date.ResultsDuring the study period, we identified 16,251 start-of-care delays (34% of home health care episodes), with 14% of episodes resulting in 30-day rehospitalization and ED visits. Delayed episodes had 12% higher odds of rehospitalization or ED visit (OR 1.12; 95% CI: 1.06–1.18) compared with episodes with timely care.Conclusions and ImplicationsThe findings suggest that timely start-of-care home health care nursing visit is associated with reduced rehospitalization and ED use among patients discharged from hospitals. With more than 6 million patients who receive home health care services across the United States, there are significant opportunities to improve timely care delivery to patients and improve clinical outcomes.     

A model of prehospital death from ventricular fibrillation following myocardial infarction.

Current efforts to reduce prehospital cardiac mortality focus more on deployment of specially equipped ambulances than on reduction of patient or ambulance delays. To evaluate this strategy, we needed to find a method that would isolate the separate effects of patient delay, ambulance delay, and the resuscitative capability of the ambulance. Using published data, we have generated a mathematical model of death from ventricular fibrillation following myocardial infarction that shows the relationship among these three factors. Analyses based on the model indicate that the potential life saving impact of a defibrillation-equipped ambulance is severely limited due to typical patient response patterns. If the ambulance arrives ten minutes after the onset of infarction, defibrillation capabilities will reduce prehospital mortality from 6 percent to 2 percent. After a more typical delay of 60 minutes, the mortality rises sharply to 13 percent for an unequipped ambulance. With a delay of this length, defibrillation capabilities reduce mortality only to about 12 percent.     

Evaluation of the status of access to emergency care of subjects with myocardial infarction

This study, undertaken in the Bas-Rhin area of France by the MONICA Register, presents the evaluation of the procedures followed for 323 subjects under 65 years old suffering from an acute myocardial infarction and subsequently hospitalized for this reason. We observe that 87.5% of the patients first consult a private practitioner -- for the most part a non specialist -- while 9% first contact a mobile coronary unit. 3.5% of patients go directly to hospital. Concerning delays in hospitalization, 35% of patients more than 6 hours to consult a doctor, while the median time between the onset of symptoms and the first call for medical aid is 2 hours. The median delay between the onset of symptoms and arrival at hospital is 5hrs 45 min., 28% of the subjects requiring more than 24 hours to be hospitalized.     

Ischemic stroke in Morocco: Prehospital delay and associated factors

ObjectivesThis study aimed to estimate prehospital delay and to identify the factors associated with the late arrival of patients with ischemic stroke at the Souss Massa Regional Hospital Center in Morocco.Patients and methodsAn observational, prospective, cross-sectional study was conducted from March 2019 to September 2019 in the Souss Massa regional hospital center, which is a public hospital structure. A questionnaire was administered to patients with ischemic stroke and to bystanders (family or others), while clinical and paraclinical data were collected from medical records. Univariate and multivariate logistic regression analyses were used to identify the factors associated with delayed arrival at emergency department.ResultsA total of 197 patients and 197 bystanders who fulfilled the criteria for the study were included. The median time from symptom onset to hospital arrival was 6 hours (IQR, 4–16). Multiple regression analysis showed that illiteracy (OR 38.58; CI_95%: 3.40–437.27), waiting for symptoms to disappear (patient behavior) (OR 11.24; CI_95%: 1.57–80.45), deciding to go directly to the hospital (patient behavior) (OR 0.07; CI_95%: 0.01–0.57), bystander's knowledge that stroke is a disease requiring urgent care within a limited therapeutic window (OR 0.005; CI_95%: 0.00–0.36), and direct admission without reference (OR 0.005; CI_95%: 0.00–0.07), were independently associated with late arrival (> 4.5 hours) of patients with acute ischemic stroke. In addition, illiteracy (OR 24.62; CI_95%: 4.37–138.69), vertigo and disturbance of balance or coordination (OR 0.14; CI_95%: 0.03–0.73), the relative's knowledge that stroke is a disease requiring urgent care and within a limited therapeutic window (OR 0.03; CI_95%: 0.00–0.22), calling for an ambulance (relative's behavior) (OR 0.16; CI_95%: 0.03–0.80), distance between 50 and 100 km (OR 10.16; CI_95%: 1.16–89.33), and direct admission without reference (OR 0.03; CI_95%: 0.00–0.14), were independently associated with late arrival (> 6 hours) of patients with acute ischemic stroke.ConclusionPatient behavior, bystander knowledge and direct admission to the competent hospital for stroke care are modifiable factors potentially useful for reducing onset-to-door time, and thereby increasing the implementation rates of acute stroke therapies.     

急诊内科昏迷患者的临床分析

目的分析急诊内科不明原因昏迷患者的三间分布、病因构成及对预后的影响。 方法选择2016年9月至2018年8月进入惠州市第一人民医院急诊内科以"急性昏迷"为主诉，且无明确诊断及可以解释昏迷原因的424例患者为研究对象，进行回顾性病例分析研究。纳入患者男性：女性为1∶1.16，统计分析患者的三间分布、确诊手段、最终确诊病因及预后情况。 结果不明原因的昏迷主要发生于中老年、乡村人群，且高发于春冬季。88%的患者最终在住院期间确诊，主要是通过脑部影像学检查[23.1%(98/424)]、结合体格检查的检验结果[25.0%(106/424)]来完成确诊。最常见急诊不明原因昏迷的病因是：脑血管疾病[24.1%(102/424)]、感染[14.2%(60/424)]、中毒[9.0%(38/424)]、癫痫发作[8%(34/424)]、代谢性疾病[7.1%(30/424)]、精神性疾病[6.1%(26/424)]等。92.0%(390/424)的急诊不明原因昏迷患者在入院时的急诊严重指数(ESI)分级为1 ～ 3级，格拉斯评分(GCS)以轻度昏迷为主：13 ～ 14分[29.7%(126/424)]、15分[32.6%(138/424)]。患者死于诊室的病死率为1.4%(6/424)。出院后仍需继续治疗如康复训练占35.4%(150/424)，在养老院继续治疗占11.1%(47/424)。 结论急性昏迷的病因诊断谱广且患者死亡风险高，脑血管疾病是其最常见的病因。ESI分级和GCS评分可帮助识别大多数死亡高位风险的患者。为明确诊断，神经系统检查如脑部影像学检查、体格检查和实验室检验等必不可少。跨学科协作对于提高急诊昏迷患者的病因诊断效率和准确率是有益的。     

National Hospital Ambulatory Medical Care Survey: 2004 emergency department summary

OBJECTIVES: This report describes ambulatory care visits to hospital emergency departments (EDs) in the United States in 2004. Statistics are presented on selected hospital, patient, and visit characteristics. Selected trends in ED utilization from 1994 through 2004 are also presented. METHODS: The data presented in this report were collected in the 2004 National Hospital Ambulatory Medical Care Survey (NHAMCS), a national probability sample survey of visits to emergency and outpatient departments of non-Federal, short-stay, and general hospitals in the United States. Sample data are weighted to produce annual national estimates. RESULTS: During 2004, an estimated 110.2 million visits were made to hospital EDs, about 38.2 visits per 100 persons. Visit rates have shown an increasing trend since 1994 for persons aged 22-49 years, 50-64 years, and 65 years and over. In 2004, more than 16 million patients arrived by ambulance (15.1 percent). At approximately 3 percent of visits, the patient had been seen in the ED within the last 72 hours. Abdominal pain, chest pain, fever, and back symptoms were the leading patient complaints, accounting for nearly one-fifth of all visits. Abdominal pain was the leading illness-related diagnosis at ED visits. There were an estimated 41.4 million injury-related visits or 14.4 visits per 100 persons. Diagnostic and screening services were provided at 89.9 percent of ED visits. Procedures were performed at 47.7 percent, and medications were prescribed at 78.4 percent of ED visits. Approximately 13 percent of ED visits resulted in hospital admission. On average, patients spent 3.3 hours in the ED, of which 47.4 minutes were spent waiting to see a physician.     

Paediatric utilization of an emergency department in Italy

BACKGROUND: The purpose of this study was to determine the frequency and characteristics of paediatric attendance as a source of medically non-urgent problems at an accident and emergency department (ED) of a public non-teaching hospital in Crotone (Italy). METHODS: For each patient aged 16 years or younger, there were collected information on demographics and socioeconomic characteristics, medical history, route of referral, clinical complaints that they presented at the moment of their presentation at the ED, duration of presenting problems prior to arrival, hour of arrival, day of the week of arrival, and reason for attending the ED. Data about the consultation process and the final decision made were also recorded. RESULTS: Of a total of 980 patients included in the study, 27.6% had conditions that were definitely non-urgent. Multiple logistic regression analysis showed that the visit was non-urgent in younger population, in females, and in those attending the ED on the weekend. The results of the second multivariable regression analysis model indicate that patients who did not receive medical or surgical examination at the ED, with problems of longer duration prior to arrival at the ED, with non-traumatic injuries, and who did not require inpatient hospital admission were more likely to use the ED as a source of non-urgent care. The most frequent presenting problems for patient visits to ED were injury, respiratory diseases, and digestive symptoms. CONCLUSION: A closer cooperation within the health care organization system to provide a service responsive to the real needs of patients is essential.