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Tertiary paediatric emergency department use in children and young people with cerebral palsy
Elaine Meehan1,2, Susan M Reid1,2, Katrina Williams1,2,3
1Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.
Insights
Many children with cerebral palsy (CP) use tertiary pediatric emergency departments (EDs) appropriately. However, some families bypass local services for non-urgent issues, suggesting a need for improved primary care and non-specialized ED pathways.
Area of Science:
- Pediatric Emergency Medicine
- Cerebral Palsy Management
- Healthcare Utilization
Background:
- Cerebral palsy (CP) is a complex neurological condition requiring specialized care.
- Understanding healthcare access patterns is crucial for optimizing service delivery.
- Tertiary pediatric emergency departments (EDs) serve a critical role for critically ill children.
Purpose of the Study:
- To delineate the utilization patterns of tertiary pediatric EDs by children and young people with CP.
- To identify factors associated with ED presentations in this cohort.
- To inform strategies for improving care pathways and reducing potentially unnecessary ED visits.
Main Methods:
- Retrospective analysis of ED data from two tertiary pediatric hospitals in Victoria, Australia.
- Cross-matching ED records with the Victorian Cerebral Palsy Register for individuals born 1993-2008.
- Inclusion of 2183 registered individuals with CP in the analysis.
Main Results:
- 37% of the CP cohort presented to tertiary pediatric EDs between 2008-2012, accounting for 3631 presentations.
- Presenters were more likely to be younger, non-ambulant, and have epilepsy.
- 71% of presentations were triaged as urgent (Australasian Triage Scale 1-3), with 44% resulting in admission; respiratory, neurological, and gastrointestinal disorders were common reasons.
Conclusions:
- A significant proportion of tertiary pediatric ED presentations for children with CP are appropriate, indicated by high urgency and admission rates.
- Evidence suggests some families bypass local services, leading to potentially avoidable tertiary ED use.
- Developing alternative care pathways and enhancing primary care/non-pediatric ED management could optimize resource allocation.
Aims:
The aim of this study was to describe the pattern of tertiary paediatric emergency department (ED) use in children and young people with cerebral palsy (CP).
Methods:
A retrospective analysis of ED data routinely collected at the two tertiary paediatric hospitals in Victoria, Australia, cross-matched with the Victorian Cerebral Palsy Register. Data pertaining to the ED presentations of 2183 registered individuals born 1993-2008 were obtained.
Results:
Between 2008 and 2012, 37% (n = 814) of the CP cohort had 3631 tertiary paediatric ED presentations. Overall, 40% (n = 332) of presenters were residing in inner metropolitan Melbourne; 44% (n = 356) in outer Melbourne; and 13% (n = 108) in regional Victoria. Presenters were more likely than non-presenters to be younger, non-ambulant and have epilepsy. In total, 71% of presentations were triaged as Australasian Triage Scale 1-3 (urgent), and 44% resulted in a hospital admission. Disorders of the respiratory, neurological and gastrointestinal systems, and medical device problems were responsible for 72% of presentations.
Conclusion:
Many of the tertiary paediatric ED presentations in this group were appropriate based on the high admission rate and the large proportion triaged as urgent. However, there is evidence that some families are bypassing local services and travelling long distances to attend the tertiary paediatric ED, even for less urgent complaints that do not require hospital admission. Alternative pathways of care delivery, and strategies to promote the management of common problems experienced by children and young people with CP in non-paediatric EDs or primary care settings, may go some way towards reducing unnecessary tertiary paediatric ED use in this group.
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