The most common diagnoses and costs of paediatric emergency department visits: A population‐based cohort study

Abstract Objectives We compared the addition of iPad distraction to standard care, versus standard care alone, to manage the pain and distress of intravenous (IV) cannulation. Methods Eighty-five children aged 6 to 11 years requiring IV cannulation (without child life services present) were recruited for a randomized controlled trial from a paediatric emergency department. Primary outcomes were self-reported pain (Faces Pain Scale-Revised [FPS-R]) and distress (Observational Scale of Behavioral Distress-Revised [OSBD-R]), analyzed with two-sample t-tests, Mann–Whitney U-tests, and regression analysis. Results Forty-two children received iPad distraction and 43 standard care; forty (95%) and 35 (81%) received topical anesthesia, respectively (P=0.09). There was no significant difference in procedural pain using an iPad (median [interquartile range]: 2.0 [0.0, 6.0]) in addition to standard care (2.0 [2.0, 6.0]) (P=0.35). There was no significant change from baseline behavioural distress using an iPad (mean ± SD: 0.53 ± 1.19) in addition to standard care (0.43 ± 1.56) (P=0.44). Less total behavioural distress was associated with having prior emergency department visits (odds ratio [95% confidence interval]: −1.90 [−3.37, −0.43]) or being discharged home (−1.78 [−3.04, −0.52]); prior hospitalization was associated with greater distress (1.29 [0.09, 2.49]). Significantly more parents wished to have the same approach in the future in the iPad arm (41 of 41, 100%) compared to standard care (36 of 42, 86%) (P=0.03). Conclusions iPad distraction during IV cannulation in school-aged children was not associated with less pain or distress than standard care alone. The effects of iPad distraction may have been blunted by topical anesthetic cream usage. Clinical trials registration ClinicalTrials.gov: NCT02326623.

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Evaluation of compliance with early postbirth follow-up and unnecessary visits to the paediatric emergency department: a prospective observational study at the Lenval Children’s Hospital in Nice

BMJ Open ◽

10.1136/bmjopen-2021-056476 ◽

2022 ◽

Vol 12 (1) ◽

pp. e056476

Author(s):

Antoine Tran ◽

Anne-Laure Hérissé ◽

Marion Isoardo ◽

Petri Valo ◽

Anne-Marie Maillotte ◽

...

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Care Pathway ◽

Emergency Department Visits ◽

Secondary Outcome ◽

Medical Visit ◽

Paediatric Emergency Department ◽

Factors Associated ◽

Paediatric Emergency

ObjectiveTo evaluate compliance with the French National Authority for Health’s (Haute Autorité de Santé, HAS) postbirth follow-up recommendations for newborns attending our paediatric emergency department (PED) and identify risk factors associated with non-compliance and unnecessary emergency department utilisation.DesignProspective, single centre.SettingFourth biggest PED in France in terms of attendance (CHU-Lenval).Patients280 patients of whom 249 were included in the statistical analysis.Main outcome measuresThe primary outcome of this study was the evaluation of compliance of the care pathway for newborns consulting at the PED with respect to the French postbirth follow-up recommendations. Secondary outcome was the assessment of whether the visit to the PED was justified by means of PED reception software and two postconsultation interviewsResults77.5% (193) of the newborns had non-compliant care pathways and 43% (107) of PED visits were unnecessary. Risk factors associated with a non-compliance regarding the HAS’s postbirth follow-up recommendations were: unnecessary visit to the PED (OR 2.0, 95% CI 1.1 to 3.9), precariousness (OR 2.8, 95% CI 1.4 to 6.2), birth in a public maternity hospital (OR 2.5, 95% CI 1.3 to 4.8) and no information about HAS’s postbirth follow-up recommendations on discharge from maternity ward (OR 11.4, 95% CI 5.8 to 23.3). Risk factors for unnecessary PED visits were: non-compliant care pathway (OR 2.0, 95% CI 1.1 to 3.9) and a first medical visit at a PED (OR 1.8, 95% CI 1.1 to 3.1).ConclusionPostbirth follow-up may lead to decrease unnecessary emergency department visits unnecessary emergency department visits.Trial registration numberThe study bears the clinical trial number NCT02863627.

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A28 INCREASED EMERGENCY DEPARTMENT VISITS AND HOSPITALIZATIONS FOR INFECTIOUS DISEASES IN ELDERLY PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A POPULATION-BASED MATCHED COHORT STUDY

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwz006.027 ◽

2019 ◽

Vol 2 (Supplement_2) ◽

pp. 54-55

Author(s):

E Kuenzig ◽

S Murthy ◽

T A Stukel ◽

G C Nguyen ◽

G G Kaplan ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Emergency Department ◽

Cohort Study ◽

Infectious Diseases ◽

Elderly Patients ◽

Bowel Disease ◽

Population Based ◽

Emergency Department Visits ◽

Matched Cohort ◽

Inflammatory Bowel

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Comparing resource use between paediatric emergency department visits by triage level

Emergency Medicine Journal ◽

10.1136/emermed-2017-207192 ◽

2018 ◽

pp. emermed-2017-207192

Author(s):

Margaret E Samuels-Kalow ◽

Matthew Niedzwiecki ◽

Ari B Friedman ◽

Peter E Sokolove ◽

Renee Y Hsia

Keyword(s):

Emergency Department ◽

Resource Use ◽

Emergency Department Visits ◽

Paediatric Emergency Department ◽

Paediatric Emergency ◽

Triage Level

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1578 The Correlation Between C-Reactive Protein and Serious Bacterial Infection in a Tertiary Paediatric Emergency Department: An Observational Case-Controlled Cohort Study

Archives of Disease in Childhood ◽

10.1136/archdischild-2012-302724.1578 ◽

2012 ◽

Vol 97 (Suppl 2) ◽

pp. A446-A447

Author(s):

M. Barrett ◽

J. Pollock ◽

T. Harney ◽

S. Yeung ◽

K. Laffan ◽

...

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Bacterial Infection ◽

C Reactive Protein ◽

Paediatric Emergency Department ◽

Reactive Protein ◽

Paediatric Emergency

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Impact of physician-based palliative care delivery models on health care utilization outcomes: A population-based retrospective cohort study

Palliative Medicine ◽

10.1177/02692163211009440 ◽

2021 ◽

pp. 026921632110094

Author(s):

Catherine R L Brown ◽

Colleen Webber ◽

Hsien-Yeang Seow ◽

Michelle Howard ◽

Amy T Hsu ◽

...

Keyword(s):

Emergency Department ◽

Palliative Care ◽

Cohort Study ◽

Healthcare Utilization ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Home Visit ◽

Population Based ◽

Emergency Department Visits ◽

Care Model

Background: Increasing involvement of palliative care generalists may improve access to palliative care. It is unknown, however, if their involvement with and without palliative care specialists are associated with different outcomes. Aim: To describe physician-based models of palliative care and their association with healthcare utilization outcomes including: emergency department visits, acute hospitalizations and intensive care unit (ICU) admissions in last 30 days of life; and, place of death. Design: Population-based retrospective cohort study using linked health administrative data. We used descriptive statistics to compare outcomes across three models (generalist-only palliative care; consultation palliative care, comprising of both generalist and specialist care; and specialist-only palliative care) and conducted a logistic regression for community death. Setting/participants: All adults aged 18–105 who died in Ontario, Canada between April 1, 2012 and March 31, 2017. Results: Of the 231,047 decedents who received palliative services, 40.3% received generalist, 32.3% consultation and 27.4% specialist palliative care. Across models, we noted minimal to modest variation for decedents with at least one emergency department visit (50%–59%), acute hospitalization (64%–69%) or ICU admission (7%–17%), as well as community death (36%–40%). In our adjusted analysis, receipt of a physician home visit was a stronger predictor for increased likelihood of community death (odds ratio 9.6, 95% confidence interval 9.4–9.8) than palliative care model (generalist vs consultation palliative care 2.0, 1.9–2.0). Conclusion: The generalist palliative care model achieved similar healthcare utilization outcomes as consultation and specialist models. Including a physician home visit component in each model may promote community death.

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