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Determining the common medical presenting problems to an accident and emergency department
K Armon1, T Stephenson, V Gabriel
1Academic Division of Child Health, School of Human Development, Medical Faculty, University of Nottingham, Nottingham NG7 2UH, UK. mk.armon@ntlworld.com
Insights
This study identified the most frequent medical reasons children visit accident and emergency departments. Guidelines should focus on common issues like breathing difficulty and febrile illness, primarily for junior doctors.
Area of Science:
- Pediatric Emergency Medicine
- Public Health
Background:
- Accident and Emergency (A&E) departments manage a high volume of pediatric cases.
- Understanding common medical presentations is crucial for optimizing A&E services.
Purpose of the Study:
- To identify and analyze the most common medical presenting problems in children attending a pediatric A&E department.
- To inform the development of targeted A&E guidelines.
Main Methods:
- Prospective study of all A&E attendances over one year (February 1997-1998).
- Data collected on children aged 0-15 years at a Nottingham A&E department.
- Categorization of diagnoses into trauma/surgical, medical, and unclassified.
Main Results:
- A total of 38,982 children attended; 10,369 (27%) had medical issues.
- Top medical problems: breathing difficulty (31%), febrile illness (20%), diarrhea (16%), abdominal pain (6%), seizure (5%), rash (5%).
- Senior house officers managed 78% of medical cases.
Conclusions:
- Six common medical problem categories account for 83% of pediatric A&E attendances.
- A&E guidelines should prioritize these common conditions.
- Guidelines should be tailored for senior house officers, who manage the majority of these cases.
Abstract:
All accident and emergency (A&E) attendances over a one year period were prospectively studied in order to determine common medical presenting problems. Data were collected on children (0-15 years) attending a paediatric A&E department in Nottingham between February 1997 and February 1998. A total of 38 982 children were seen. The diagnoses of 26 756 (69%) were classified as trauma or surgical, and 10 369 (27%) as medical; 1857 (4%) could not be classified. The commonest presenting problems reported for "medical" children were breathing difficulty (31%), febrile illness (20%), diarrhoea with or without vomiting (16%), abdominal pain (6%), seizure (5%), and rash (5%). The most senior doctor seeing these patients in A&E was a senior house officer (intern or junior resident) in 78% of cases, paediatric registrar (senior resident) in 19%, consultant (attending physician) in 1.4%, and "other" in 2.6%. Guidelines developed for A&E should target the commonest presenting problem categories, six of which account for 83% of all medical attendances, and be directed towards senior house officers.