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Comparing emergency department presentations among children with cerebral palsy with general childhood presentations:
Elaine Meehan1,2, Katrina Williams1,2, Susan M Reid1,2
1Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
Insights
Children with cerebral palsy (CP) represent 0.4% of emergency department visits. These children have more urgent presentations, require ambulance services more often, and are admitted to the hospital more frequently than their peers.
Area of Science:
- Pediatrics
- Public Health
- Emergency Medicine
Background:
- Children with cerebral palsy (CP) have unique healthcare needs.
- Understanding their emergency department (ED) utilization is crucial for resource allocation and care planning.
Purpose of the Study:
- To determine the proportion of ED presentations attributable to children with CP.
- To analyze the frequency and characteristics of ED visits in a CP cohort.
- To compare ED utilization patterns between children with CP and the general pediatric population.
Main Methods:
- A retrospective cohort study linking the Victorian Cerebral Palsy Register with the Victorian Emergency Minimum Dataset.
- Analysis of ED presentations for children with CP and a population control group from 2007 to 2014.
Main Results:
- Children with CP accounted for 0.4% of all childhood ED presentations (7015 visits in the cohort).
- ED visits per 1000 children with CP increased with CP severity.
- Presentations in the CP cohort were more likely to involve ambulance arrival (27% vs 8%), urgent triage (66% vs 32%), and hospital admission (38% vs 12%) compared to controls.
Conclusions:
- Children with cerebral palsy have significantly different emergency department utilization patterns compared to the general pediatric population.
- Higher rates of urgent presentations, ambulance use, and hospital admissions highlight potential gaps in primary care access or management of chronic conditions.
- Current ED triage scales may require adaptation for children with CP due to their distinct presentation characteristics.
Aim:
The aims of this study were to estimate the proportion of emergency department presentations attributable to children with cerebral palsy (CP), investigate the frequency of emergency department presentations in a CP cohort, and compare emergency department presentations among children with CP with those of other children.
Method:
This was a retrospective cohort study. The Victorian Cerebral Palsy Register was linked to the Victorian Emergency Minimum Dataset. Data on emergency department presentations for the CP cohort occurring between 2007 and 2014 and population control data were obtained.
Results:
The CP cohort (n=1748) had 7015 emergency department presentations during the 7-year period, accounting for 0.4% of the 1.69 million age-specific presentations during that time. The number of annual presentations per 1000 children rose with increasing CP severity. Compared with presentations among the general population, higher proportions of presentations among the CP cohort were preceded by ambulance arrivals (27% vs 8%), triaged as urgent (66% vs 32%), and required hospital admission (38% vs 12%).
Interpretation:
The marked differences in presentations between the CP cohort and the general population in the proportions that were urgent and required ambulance arrivals and hospital admissions was an important finding. Strategies to ensure appropriate use of services, including encouragement to seek earlier assistance from primary care providers, may prevent problems escalating to the need for urgent care.
What This Paper Adds:
Children with cerebral palsy (CP) account for 0.4% of childhood emergency department presentations. More emergency department presentations among children with CP require ambulance arrival. More CP emergency department presentations are urgent and require hospital admission. Traditional emergency department triage scales seem less accurate for this group.
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