Too long in the tooth: a descriptive study of adults presenting to a pediatric emergency department

To describe the demographics, presenting complaints, diagnoses, and disposition of adults presenting to an Australian pediatric emergency department. It was hypothesized that most patients would be younger than 20 years, with low acuity complaints predominantly related to minor injuries resulting in a low admission rate.

A prospective cohort of new adult patients (age, > or = 16 years) were recruited. Baseline data was recorded for all eligible patients. Consenting patients had provisional diagnoses recorded along with disposition decisions. Patients' records were reviewed at the referral destination to establish the final diagnoses and the admission rate.

Forty-eight patients (0.6% of all presentations) presented during the study period. The median age was 17.5 years (interquartile range, 16.3-26.1 years). Thirty-four patients (70.8%) were younger than 20 years (P = 0.003). Seven (14.6%) patients had an Australasian Triage Scale score of 2, and 19 (39.6%) had a score of 3. Injury-related complaints formed the largest proportion of presentations (mean, 37.5%; range, 23.8%-51.2%). Thirty-one patients were enrolled in the study. Twenty (mean, 48.8%; range, 33.5%-64.1%) of the provisional diagnoses in this group were injury-related. Twenty-nine patients (mean, 93.5%; range, 84.9%-100%) were advised to seek further medical attention. Injuries comprised the largest group of final diagnoses (mean, 55.2%; range, 37.1%-73.3%). Five patients (mean, 16.1%; range, 3.2%-29%) were admitted.

Adult presentations were not infrequent. Twenty patients (41.7%) were within 1 year of the age cutoff at Princess Margaret Hospital. Although 45.8% of presentations had a low acuity, the majority of patients had Australasian Triage Scale scores of 2 or 3. The presentations were heterogeneous in nature, with injuries accounting for a large proportion. Most patients were referred for further care, but a minority were not compliant with follow-up instructions. There was a low admission rate.