Related Experiment Video
Updated: May 8, 2026
A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
Unfavourable outcome for children leaving the emergency department without being seen by a physician
Insights
Approximately 2% of pediatric emergency department patients leaving without physician evaluation experienced adverse outcomes. Trauma-related complaints and lack of nurse counseling increased this risk, highlighting areas for improved patient safety.
Area of Science:
- Pediatric Emergency Medicine
- Patient Safety Research
- Healthcare Outcomes Analysis
Background:
- Children leaving emergency departments without being seen (LWBS) pose a patient safety concern.
- Defining and quantifying adverse outcomes in this population is crucial for risk mitigation.
Purpose of the Study:
- To determine the prevalence of unfavorable outcomes among children who left the emergency department without being seen by a physician.
- To identify predictors associated with adverse outcomes in this pediatric cohort.
Main Methods:
- Prospective cohort study over one year in a pediatric tertiary care emergency department.
- Phone follow-up of children younger than 19 who left without being seen.
- Unfavorable outcomes defined by hospitalization, invasive procedures, suicide attempt, or death within 72 hours.
Main Results:
- Of 7,592 children who left without being seen, 1,579 were contacted, and 2.4% experienced an unfavorable outcome.
- Chief complaints related to trauma and absence of nurse counseling were associated with higher risks of adverse outcomes.
Conclusions:
- A small but significant proportion of children leaving the pediatric emergency department without physician evaluation experience adverse outcomes.
- Targeted interventions for trauma patients and ensuring nurse counseling may reduce risks for children LWBS.
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.
Related Concept Videos
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:26Endoscopic Procedures V: ERCP
Patient...
01:11Guidelines for Writing Outcome
Patient outcomes reflect the patient's response to the goal rather than what the nurse aims to achieve. Terminology should be observable and measurable to avoid the reader's interpretation. The desired outcome should be realistic and achievable in the designated care timeframe. Expected outcomes should align with adjunctive therapies. The outcome should enhance care evaluation by...
01:26Endoscopic Studies II: Thoracocentesis
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
02:09Bystander Effect
01:10Documentation of Nursing Diagnosis
In some settings, data-driven computerized decision support systems are in place, allowing for more accurate nursing diagnoses. The database within one of these systems includes diagnostic labels defining characteristics, activities, and indicators for nursing. A nurse enters assessment...