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Characteristics of frequent paediatric users of emergency departments in England: an observational study using
Geva Greenfield1, Mitch Blair2, Paul P Aylin2
1Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK g.greenfield@ic.ac.uk.
Insights
One in 11 children frequently attend emergency departments (EDs). Infants and children from deprived areas are most likely to be frequent ED users, requiring targeted interventions.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Public Health
Background:
- Frequent emergency department (ED) attendances by children strain healthcare resources.
- Characteristics of frequent pediatric ED users are not well understood.
- Understanding these patterns is crucial for optimizing pediatric care delivery.
Purpose of the Study:
- To quantify the prevalence of frequent pediatric ED attendance in England.
- To identify demographic factors associated with frequent pediatric ED use.
Main Methods:
- Analysis of the Hospital Episode Statistics dataset (April 2014-March 2017).
- Inclusion of over 2.3 million children under 16 with at least one ED visit.
- Definition of frequent users as those with four or more ED attendances in 2015/2016.
- Use of mixed-effects logistic regression to analyze sociodemographic predictors.
Main Results:
- 9.1% of pediatric ED attenders (1 in 11) were classified as frequent users.
- Infants showed a significantly higher likelihood of frequent attendance (OR 3.24).
- Children from deprived areas (OR 1.57) and boys (OR 1.05) had increased odds of frequent ED use.
- Ethnic variations were observed, with Asian and mixed groups more likely, and Black and 'other' groups less likely, than White children.
Conclusions:
- Frequent pediatric ED attendance affects a significant minority of children.
- Interventions should prioritize infants and children residing in socioeconomically deprived areas.
- Addressing underlying social determinants is key to reducing frequent pediatric ED visits.
Background:
Frequent attendances of the same users in emergency departments (ED) can intensify workload pressures and are common among children, yet little is known about the characteristics of paediatric frequent users in EDs.
Aim:
To describe the volume of frequent paediatric attendance in England and the demographics of frequent paediatric ED users in English hospitals.
Method:
We analysed the Hospital Episode Statistics dataset for April 2014-March 2017. The study included 2 308 816 children under 16 years old who attended an ED at least once. Children who attended four times or more in 2015/2016 were classified as frequent users. The preceding and subsequent years were used to capture attendances bordering with the current year. We used a mixed effects logistic regression with a random intercept to predict the odds of being a frequent user in children from different sociodemographic groups.
Results:
One in 11 children (9.1%) who attended an ED attended four times or more in a year. Infants had a greater likelihood of being a frequent attender (OR 3.24, 95% CI 3.19 to 3.30 vs 5 to 9 years old). Children from more deprived areas had a greater likelihood of being a frequent attender (OR 1.57, 95% CI 1.54 to 1.59 vs least deprived). Boys had a slightly greater likelihood than girls (OR 1.05, 95% CI 1.04 to 1.06). Children of Asian and mixed ethnic groups were more likely to be frequent users than those from white ethnic groups, while children from black and 'other' had a lower likelihood (OR 1.03, 95% CI 1.01 to 1.05; OR 1.04, 95% CI 1.01 to 1.06; OR 0.88, 95% CI 0.86 to 0.90; OR 0.90, 95% CI 0.87 to 0.92, respectively).
Conclusion:
One in 11 children was a frequent attender. Interventions for reducing paediatric frequent attendance need to target infants and families living in deprived areas.
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