Patients who leave the pediatric emergency department without being seen: a case-control study

Goldman, Ran D.; Macpherson, Alison; Schuh, Suzanne; Mulligan, C.; Pirie, Jonathan

doi:10.1503/cmaj.1031817

Cited by 65 publications

(93 citation statements)

References 17 publications

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“…[3][4][5][6] Recent publications report proportions of LWBS varying between 1 and 17%, with a mean of approximately 5%. 4,[6][7][8][9] As these patients may have important clinical outcomes, the rate of patients who LWBS has been considered one of the most important performance indicators for pediatric EDs. 10,11 There is very little information regarding the outcome of patients who LWBS and the morbidity engendered by the problem.…”

Section: Ré Sumémentioning

confidence: 99%

“…10,11 There is very little information regarding the outcome of patients who LWBS and the morbidity engendered by the problem. Pediatric studies suggest that approximately 50% of these patients visit a physician within the following days 7,12,13 and approximately 2% are hospitalized. 3,7 The major limitations of these studies are related to the small number of participants and the lack of comprehensive evaluation of LWBS predictors.…”

Section: Ré Sumémentioning

confidence: 99%

“…Pediatric studies suggest that approximately 50% of these patients visit a physician within the following days 7,12,13 and approximately 2% are hospitalized. 3,7 The major limitations of these studies are related to the small number of participants and the lack of comprehensive evaluation of LWBS predictors. A literature review concluded in 2008 that ''patients generally have very low rates of subsequent admission, and reports of serious adverse events are rare.''…”

Section: Ré Sumémentioning

confidence: 99%

“…7,12 Using a proportion of unfavourable outcome of 3%, it was calculated that the recruitment of 1,667 participants would yield at least 50 children with an unfavourable outcome. The computerized database of the study setting reported that more than 10,000 children per year left prematurely in the 2 previous years.…”

Section: Sample Sizementioning

confidence: 99%

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Unfavourable outcome for children leaving the emergency department without being seen by a physician

Gravel

Gouin

Carrière

et al. 2013

CJEM

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Objective: To assess the prevalence of an unfavourable outcome among children leaving without being seen by a physician in the emergency department (ED).Method: This was a prospective cohort study conducted over a complete year in a pediatric tertiary care ED. A random sample of all children younger than 19 years of age who left without being seen by a physician was contacted by phone 4 to 6 days following the ED visit. The primary outcome was the occurrence of an unfavourable outcome prospectively defined using a Delphi method among 15 pediatric emergency physicians. An unfavourable outcome was defined as hospitalization, the need for an invasive procedure (intravenous or intramuscular medication, fracture reduction, bone casting, or surgical intervention), suicide attempt, or death in the 72 hours following leaving without being seen by a physician. As a secondary outcome, multiple potential predictors were evaluated. The first analysis evaluated the proportion of unfavourable outcomes among children who left without being seen by a physician. Then logistic regression identified predictors of unfavourable outcomes. Results: During the study period, 61,909 children presented to the ED, 7,592 (12%) left without being seen by a physician, and 1,579 were recruited. Thirty-eight (2.4%; 95% CI 1.7-3.2) patients fulfilled the criteria for an unfavourable outcome. On multiple logistic regression, chief complaints related to trauma and absence of nurse counseling had higher risks of unfavourable outcome.Conclusions: Approximately 2% of children who left without being seen by a physician at a tertiary care pediatric ED had an unfavourable outcome. RÉ SUMÉObjectif: L'é tude visait à é valuer la pré valence des é vé nements dé favorables survenus chez les enfants qui quittent le service d'urgence (SU) sans avoir é té vus par un mé decin. Mé thode: Il s'agit d'une é tude de cohortes prospective, d'une duré e de 1 an, mené e dans un SU de soins tertiaires en pé diatrie. Un certain nombre d'enfants choisis au hasard, parmi tous ceux qui avaient moins de 19 ans et qui avaient quitté le SU sans avoir é té vus par un mé decin, ont é té joints par té lé phone, de 4 à 6 jours aprè s la demande de consultation. Le principal critè re d'é valuation consistait en la survenue d'é vé nements dé favorables, dé finis de maniè re prospective, à l'aide de la mé thode Delphi, par 15 pé diatres urgentologues. Les é vé nements dé favorables ont é té dé finis comme l'hospitalisation, la né cessité d'une intervention effractive (administration intraveineuse ou intramusculaire de mé dicaments, ré duction de fractures, pose d'un appareil plâ tré , intervention chirurgicale), une tentative de suicide, ou la mort dans les 72 heures suivant le dé part du SU sans examen pré alable par un mé decin. Quant au critè re d'é valuation secondaire, plusieurs facteurs pré visionnels possibles d'é vé nement dé favorable ont fait l'objet d'é valuation. La premiè re analyse visait à é valuer la proportion d'é vé nements dé favorables chez les enfants qui...

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Section: Ré Sumémentioning

confidence: 99%

Section: Ré Sumémentioning

confidence: 99%

Section: Ré Sumémentioning

confidence: 99%

Section: Sample Sizementioning

confidence: 99%

See 2 more Smart Citations

Unfavourable outcome for children leaving the emergency department without being seen by a physician

Gravel

Gouin

Carrière

et al. 2013

CJEM

View full text Add to dashboard Cite

show abstract

“…Reneging may be viewed as a strong statement of patient dissatisfaction. Although some patients who leave the ED without being seen have nonurgent problems, 20,21 it is clear that others have truly emergent problems that may go unattended. 22,23 Although it is difficult to predict who will leave or require further care, 24 it is known that patients are more likely to renege when wait times are long, that EDs serving a larger uninsured population tend to have higher rates of reneging, 25 and that patients who visit the ED frequently with minor problems are more likely to renege.…”

mentioning

confidence: 99%