Level of Acuity in Pediatric Patients with Recurrent Emergency Department Visits

Introduction: Recurrent ED utilizers account for a substantial proportion of ED visits, yet little data exists on children with multiple visits. The objective of this study was to compare the need for interventions and triage acuity of recurrent utilizers of a pediatric emergency department to that of non-recurrent utilizers. Methods: This is a retrospective analysis of children presenting to a pediatric emergency department. Children were classified as recurrent utilizers if they had 4 or more visits to the ED per year and non-recurrent utilizers if they had less than 4 visits. Data was collected and inter-group comparison performed on critical interventions received (admission, consultation, intravenous fluid therapy, observation, and performance of procedures), all interventions received (including critical interventions as well as laboratories, radiographs, and medications), and triage acuity for the index visit. Results: Two-hundred thirty patients were included, of whom, 15% were classified as recurrent utilizers. This group had significantly lower rates of requiring a critical intervention (8.6% vs. 51.4%, p=.001), lower rates of any intervention (51.4% vs. 74.4%, p=.007), and less urgent triage acuity (3.3 vs. 3.1, p=.029). Conclusions: Recurrent utilizers of the pediatric emergency department had significantly lower need for intervention and less urgent mean triage acuity when compared with non-recurrent utilizers.

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Adjacent Primary Care May Reduce Less Urgent Pediatric Emergency Department Visits

Journal of Primary Care & Community Health ◽

10.1177/2150132720926276 ◽

2020 ◽

Vol 11 ◽

pp. 215013272092627

Author(s):

Julia Ellbrant ◽

Jonas Åkeson ◽

Helena Sletten ◽

Jenny Eckner ◽

Pia Karlsland Åkeson

Keyword(s):

Primary Care ◽

Emergency Department ◽

Patient Characteristics ◽

Pediatric Emergency ◽

Emergency Department Visits ◽

University Hospital ◽

Pediatric Emergency Department ◽

Hospital Data ◽

Cross Sectional ◽

Ed Visits

Aims: Pediatric emergency department (ED) overcrowding is a challenge. This study was designed to evaluate if a hospital-integrated primary care unit (HPCU) reduces less urgent visits at a pediatric ED. Methods: This retrospective cross-sectional study was carried out at a university hospital in Sweden, where the HPCU, open outside office hours, had been integrated next to the ED. Children seeking ED care during 4-week high- and low-load study periods before (2012) and after (2015) implementation of the HPCU were included. Information on patient characteristics, ED management, and length of ED stay was obtained from hospital data registers. Results: In total, 3216 and 3074 ED patient visits were recorded in 2012 and 2015, respectively. During opening hours of the HPCU, the proportions of pediatric ED visits (28% lower; P < .001), visits in the lowest triage group (36% lower; P < .001), patients presenting with fever ( P = .001) or ear pain ( P < .001), and nonadmitted ED patients ( P = .033), were significantly lower in 2015 than in 2012, whereas the proportion of infants ≤3 months was higher in 2015 ( P < .001). Conclusions: By enabling adjacent management of less urgent pediatric patients at adequate lower levels of medical care, implementation of a HPCU outside office hours may contribute to fewer and more appropriate pediatric ED visits.

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Low Rates of Follow-Up With Primary Care Providers After Pediatric Emergency Department Visits for Respiratory Tract Illnesses

Pediatric Emergency Care ◽

10.1097/pec.0b013e31826c6dde ◽

2012 ◽

Vol 28 (10) ◽

pp. 956-961 ◽

Cited By ~ 16

Author(s):

Danica B. Liberman ◽

Deborah Q. Shelef ◽

Jianping He ◽

Robert McCarter ◽

Stephen J. Teach

Keyword(s):

Primary Care ◽

Emergency Department ◽

Respiratory Tract ◽

Primary Care Providers ◽

Pediatric Emergency ◽

Emergency Department Visits ◽

Pediatric Emergency Department ◽

Care Providers ◽

Respiratory Tract Illnesses

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An Interrupted Time-Series Analysis of Pediatric Emergency Department Visits During the Coronavirus Disease 2019 Pandemic

Pediatric Emergency Care ◽

10.1097/pec.0000000000002404 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Michael A. Irvine ◽

Elodie Portales-Casamar ◽

Ran D. Goldman

Keyword(s):

Emergency Department ◽

Time Series ◽

Time Series Analysis ◽

Interrupted Time Series ◽

Pediatric Emergency ◽

Emergency Department Visits ◽

Pediatric Emergency Department ◽

Interrupted Time Series Analysis ◽

Series Analysis

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Characteristics of pediatric emergency department visits for youth 10-15 years old with injuries due to interpersonal violence

International Journal of Injury Control and Safety Promotion ◽

10.1080/17457300.2021.1993267 ◽

2021 ◽

pp. 1-6

Author(s):

Leticia Manning Ryan ◽

Nathan Irvin ◽

Mattea Miller ◽

Creason Walter ◽

Vanya Jones

Keyword(s):

Emergency Department ◽

Interpersonal Violence ◽

Pediatric Emergency ◽

Emergency Department Visits ◽

Pediatric Emergency Department

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Evaluation of the Efficacy of a Onetime Injectable Dexamethasone Administered Orally in the Pediatric Emergency Department for Asthma Exacerbation

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-22.5.326 ◽

2017 ◽

Vol 22 (5) ◽

pp. 326-331

Author(s):

Ashley McCallister ◽

Tsz-Yin So ◽

Josh Stewart

Keyword(s):

Emergency Department ◽

Asthma Exacerbation ◽

Pediatric Patients ◽

Pediatric Emergency ◽

Average Weight ◽

Pediatric Emergency Department ◽

Routes Of Administration ◽

Efficacious Treatment ◽

Randomized Control ◽

To Receive

OBJECTIVE This study assessed the efficacy of injectable dexamethasone administered orally in pediatric patients who presented to the emergency department with asthma exacerbation. METHODS This was a retrospective study of patients 0 to 18 years of age who presented to and who were directly discharged from the emergency department at Moses H. Cone Memorial Hospital between September 1, 2012, and September 30, 2015, for the diagnosis of asthma or asthma exacerbation. Patients had to receive a onetime dose of injectable dexamethasone orally prior to discharge. Patients were followed for a 30-day period to identify the number of asthma relapses. RESULTS Ninety-nine patients were included in this study. The average weight-based dose ± SD of dexamethasone was 0.35 ± 0.18 mg/kg (range, 0.08–0.62 mg/kg) and the actual dose ± SD was 10.58 ± 1.92 mg (range, 5–16 mg). Over a 30-day period, 6 patients (6%) had one repeated emergency department visit, 6 patients (6%) were admitted to the hospital, and 3 patients (3%) presented to an outpatient clinic for asthma-related symptoms. CONCLUSIONS Injectable dexamethasone administered orally may be an efficacious treatment for asthma exacerbation in pediatric patients. A randomized control trial comparing injectable dexamethasone administered orally to other dexamethasone formulations/routes of administration should be performed to adequately assess the bioequivalence and effectiveness of the former formulation.

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