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Comparison of two European paediatric emergency departments: does primary care organisation influence emergency
F Poropat1, P Heinz2, E Barbi3
1University of Trieste, IRCCS-Burlo Garofolo Trieste (Italy), via dell'Istria 65/1, Trieste, 34137, Italy. poropat.federico@gmail.com.
Insights
Paediatric Emergency Department (ED) visits were higher in infants when primary care was managed by general practitioners. Paediatricians providing primary care reduced hospital admission rates by one-third.
Area of Science:
- Pediatrics
- Health Services Research
- Emergency Medicine
Background:
- Comparing paediatric Emergency Department (ED) attendances and admission outcomes.
- Investigating two European hospitals with distinct paediatric primary care systems.
Purpose of the Study:
- To compare paediatric ED attendances and admission outcomes.
- To analyze the impact of different primary care models on ED utilization and admission rates.
Main Methods:
- Retrospective prevalence study of paediatric ED attendances in 2013.
- Comparison between an Italian ED (office paediatricians) and a UK ED (general practitioners).
- Data collected on presentation reasons, diagnoses, and admission rates, with subgroup analysis by age.
Main Results:
- Higher infant ED attendance (15.4% vs 11.4%) in the UK (general practitioners) compared to Italy (paediatricians).
- Similar reasons for attendance across both EDs, with trauma most common in older children.
- Admission rates were three times higher in the UK (14.1%) versus Italy (4.8%), primarily for infectious diseases.
Conclusions:
- Infant ED attendances are more frequent with general practitioner-led primary care.
- Primary care provided by paediatricians may reduce overall paediatric ED admission rates by one-third.
- Further research is needed to confirm these findings due to study limitations and potential confounding factors.
Backround:
To compare paediatric Emergency Department (ED) attendances and admission outcomes in two European hospitals with different paediatric primary care set-up.
Methods:
This is a retrospective prevalence study comparing all paediatric ED attendances during calendar years 2013 in two EDs with similar catchment area: one in Italy (Trieste) where paediatric primary care is provided by office paediatricians, the other, in the UK (Cambridge), where paediatric primary care is provided by general practitioners. Data on reason for presentation, discharge diagnosis and admission rate were collected and sub-group analysis for specific age groups (<1 year, 1-4 years, 5-15 years) was performed.
Results:
Over 12 months, 20.331 children (0-15 years old) were seen in Cambridge and 18.646 in Trieste, with a very similar age distribution in both centres, except for the youngest age group: the percentage of infants seen in comparison with the total number of children attending ED was 1/3 higher in England than in Italy (15.4% vs 11.4%). The reasons for attendance were similar: under 1 year of age, the chief complaints were fever, breathing difficulties and gastrointestinal problems while in the older age groups trauma represented the commonest reason. Among discharge diagnoses, no differences were found between the two hospitals, except for faltering growth and "well child", more frequently diagnosed in English children under 5 years. The proportion of admissions was three times higher in Cambridge (14.1% vs 4.8%) with most children being admitted for infectious diseases.
Conclusions:
ED attendances in infants are more common in a primary care setting provided by general practicioner and, moreover, admission rates in all age groups are 1/3 reduced by primary care based paediatricians. Due to the methodological limits of this study, it isn't possible to evaluate whether these results depend only on paediatric primary care set-up or be determined by other confounding factors. New studies are needed to confirm this preliminary evidence.
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