Characteristics of frequently attending children in hospital emergency departments: a systematic review

Abstract

ObjectiveTo summarise the literature on frequent attendances to hospital emergency departments (EDs) and describe sociodemographic and clinical characteristics of children who attend EDs frequently.SettingHospital EDs.ParticipantsChildren <21 years, attending hospital EDs frequently.Primary outcome measuresOutcomes measures were defined separately in each study, and were predominantly the number of ED attendances per year.ResultsWe included 21 studies representing 6 513 627 children. Between 0.3% and 75% of all paediatric ED users were frequent users. Most studies defined four or more visits per year as a ‘frequent ED’ usage. Children who were frequent ED users were more likely to be less than 5 years old. In the USA, patients with public insurance were more likely to be frequent attenders. Frequent ED users more likely to be frequent users of primary care and have long-term conditions; the most common diagnoses were infections and gastroenteritis.ConclusionsThe review included a wide range of information across various health systems, however, children who were frequent ED users have some universal characteristics in common. Policies to reduce frequent attendance might usefully focus on preschool children and supporting primary care in responding to primary care oriented conditions.

Short stay hospital admissions for an acutely unwell child: A qualitative study of outcomes that matter to parents and professionals

“…Self-selection may have resulted in the inclusion of parents who experienced a 'significant' SSA, or had a particularly positive or negative experience, rather than those with more typical admissions. Despite being a convenience and self-selected sample, over 75% of the parents we interviewed had a child under five years of age and were seeking urgent care for an infection which concurs with published evidence on key characteristics of unscheduled hospital admissions in children [1,3,5,33]. The challenges posed by the pandemic did not impact the project's considered sample size of 72.…”

Models of integrated care for young people experiencing medical emergencies related to mental illness: a realist systematic review

“…Comorbid mental disorders are present in 10–19% of all paediatric emergencies [ 4 , 5 ], and mental illness significantly increases risk of medical emergency admission and readmissions [ 6 ]. Frequent attenders at paediatric emergency departments more commonly present with psychiatric complaints than with accidental injury [ 7 ]. Examples of physical manifestations of mental disorders are self-harm and suicide attempts, psychological trauma leading to somatisation, eating disorders leading to serious nutritional deficiencies, and substance and alcohol dependence leading to intoxication [ 5 ].…”

Maternal Emergency Department Use Before Pregnancy and Infant Emergency Department Use After Birth

“…[1][2][3][4][5] ED use not only reflects a patient's current illness or degree of medical complexity, but is an indicator of their access to primary care and availability of specialist and community-based supports. [6][7][8][9][10] Among all children, infants less than 1 year of age have the highest rates of ED use, 4,7 with recurrent ED use a sign of uncoordinated health care access and economic disparity. 11 ED use in pregnancy is common and is also reflective of poorer access to antenatal care, 12 with worse ensuing maternal and perinatal outcomes.…”

“…Emergency departments (EDs) are under enormous strain, with rising use among persons of all ages, especially children and infants . ED use not only reflects a patient’s current illness or degree of medical complexity, but is an indicator of their access to primary care and availability of specialist and community-based supports . Among all children, infants less than 1 year of age have the highest rates of ED use, with recurrent ED use a sign of uncoordinated health care access and economic disparity …”