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Referral rates for children with acute gastroenteritis: a retrospective cohort study
Pien Ingrid Wolters1, Gea Holtman1, Freek Fickweiler1
1Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
Insights
Hospital admission rates for childhood acute gastroenteritis are rising, but out-of-hours primary care referral rates have not significantly increased. This study analyzed trends in acute gastroenteritis referrals for children aged 6 months to 6 years.
Area of Science:
- Pediatric Emergency Medicine
- Primary Care
- Public Health
Background:
- Hospital admissions for pediatric acute gastroenteritis are increasing.
- The impact on primary care out-of-hours (OOH) service referral rates remains unclear.
- Increased primary care workloads may influence referral decisions.
Purpose of the Study:
- To evaluate trends in referral rates from primary care OOH services to specialist emergency care for children with acute gastroenteritis.
- To determine if rising admission rates correlate with increased OOH referrals.
- To assess changes in face-to-face contact and oral rehydration therapy (ORT) prescription rates.
Main Methods:
- Retrospective cohort study (September 2007–September 2014).
- Included children aged 6 months to 6 years presenting with acute gastroenteritis to OOH services.
- Analyzed pseudonymized data using Chi-squared trend tests for incidence, referrals, contacts, and ORT prescriptions.
Main Results:
- Over 7 years, incidence of acute gastroenteritis decreased significantly (P<0.01).
- Face-to-face contact rates significantly increased (P<0.01), especially in older children.
- Referral rates (P=0.87) and ORT prescription rates (P=0.82) showed no significant trend.
Conclusions:
- Childhood acute gastroenteritis incidence in OOH services declined, with no significant rise in referral rates.
- Findings suggest OOH services are managing gastroenteritis effectively without increased referrals.
- These results provide a benchmark for evaluating future interventions for childhood gastroenteritis.
Background:
Hospital admission rates are increasing for children with acute gastroenteritis. However, it is unknown whether this increase is accompanied by an increase in referral rates from GPs due to increased workloads in primary care out-of-hours (OOH) services.
Aim:
To assess trends in referral rates from primary care OOH services to specialist emergency care for children presenting with acute gastroenteritis.
Design & Setting:
This retrospective cohort study covered a period from September 2007-September 2014. Children aged 6 months to 6 years presenting with acute gastroenteritis to a primary care OOH service were included.
Method:
Pseudonymised data were obtained, and children were analysed overall and by age category. Χ2 trend tests were used to assess rates of acute gastroenteritis, referrals, face-to-face contacts, and oral rehydration therapy (ORT) prescriptions.
Results:
The data included 12 455 children (6517 boys), with a median age of 20.2 months (interquartile range [IQR] 11.6 to 36.0 months). Over 7 years, incidence rates of acute gastroenteritis decreased significantly, and face-to-face contact rates increased significantly (both, P<0.01). However, there was no significant trend for referral rates (P = 0.87) or prescription rates for ORT (P = 0.82). Subgroup analyses produced comparable results, although there was an increase in face-to-face contact rates for the older children.
Conclusion:
Incidence rates for childhood acute gastroenteritis presenting in OOH services decreased and referral rates did not increase significantly. These findings may be useful as a reference for the impact of new interventions for childhood acute gastroenteritis.
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