Comparing resource use between paediatric emergency department visits by triage level

Area of Science:

• Pediatric Emergency Medicine
• Health Services Research

Background:

• Most pediatric emergency department (ED) visits result in discharge.
• Resource utilization for non-urgent pediatric ED visits is not well understood.

Purpose of the Study:

• To analyze the utilization of diagnostic testing, procedures, and hospital admission for pediatric ED visits triaged as 'non-urgent'.
• To compare resource use and disposition between non-urgent and urgent pediatric ED visits.

Main Methods:

• Analysis of US ED visits for children aged 0-17 years (2009-2011) from the National Hospital Ambulatory Care Survey.
• Comparison of resource use and disposition for 'non-urgent' (triage level 5) versus urgent (triage levels 1-4) visits.
• Assessment of triage sensitivity and specificity in predicting resource use and disposition.

Main Results:

• 11.1% of pediatric ED visits were triaged as 'non-urgent'.
• Diagnostic services were used in 37.6% of non-urgent visits vs. 55.2% of urgent visits.
• 1.7% of non-urgent visits resulted in admission, compared to 4.4% of urgent visits. Triage had poor sensitivity for identifying patients not needing extensive resources.

Conclusions:

• A notable proportion of pediatric patients with non-urgent ED triage scores undergo diagnostic testing and procedures.
• Improved methods are required to identify low-acuity pediatric patients who can be managed without significant ED resources.