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Where are children seen in Australian emergency departments? Implications for research efforts
Jolene Cj Lim1, Meredith L Borland2,3, Paul M Middleton4,5,6,7,8
1Policy and Research Division, Department of Policy and Strategic Partnerships, Australasian College for Emergency Medicine, Melbourne, Victoria, Australia.
Insights
Paediatric emergency departments (EDs) differ in patient case-mix and performance metrics. Research on paediatric EDs should expand beyond tertiary centres for broader relevance.
Area of Science:
- Emergency Medicine
- Paediatric Healthcare
- Health Services Research
Background:
- Most paediatric emergency research in Australia is conducted at tertiary emergency departments (EDs).
- Understanding differences in paediatric presentations between tertiary and non-tertiary EDs is crucial for comprehensive research and policy.
- Paediatric case-mix and performance metrics can vary significantly across different healthcare settings.
Purpose of the Study:
- To compare paediatric patient case-mix and time-based performance metrics between tertiary paediatric EDs and all other EDs in Australia.
- To identify key differences in presentation reasons and patient demographics between these ED settings.
- To inform the scope and generalizability of paediatric emergency research.
Main Methods:
- A retrospective epidemiological study was conducted using national health service minimum dataset for the 2017-2018 financial year.
- Paediatric presentations (aged 0-14 years) were compared between major tertiary paediatric EDs and all other EDs.
- Definitions included 'major tertiary paediatric hospital' accredited for paediatric emergency medicine and paediatric intensive care training.
Main Results:
- 23.8% of 1,695,854 paediatric ED presentations occurred in nine major metropolitan tertiary paediatric hospitals.
- Distinctive presentation differences were noted in children aged 10-14 years, with higher rates of psychiatric and neurological illnesses in tertiary EDs.
- Australian Indigenous children were less likely to present to tertiary EDs (3.0% vs 9.7%).
- Median waiting times were longer in tertiary EDs (28 min vs 20 min), but patients were less likely to leave without being seen (5.5% vs 6.9%).
Conclusions:
- Significant differences exist in paediatric presentations and performance metrics between tertiary and non-tertiary EDs.
- Paediatric ED research needs to extend beyond tertiary centres to ensure findings are relevant and generalizable to the wider population.
- These findings highlight the need for tailored approaches to paediatric emergency care across different healthcare settings.
Objective:
With most paediatric emergency research in Australia conducted at tertiary EDs, it is important to understand how presentations differ between those at tertiary paediatric EDs and all other EDs.
Methods:
Retrospective epidemiological study assessing paediatric case-mix and time-based performance metrics (aged 0-14 years) obtained from a national health service minimum dataset for the 2017-2018 financial year, comparing tertiary paediatric EDs and all other EDs. We defined a 'major tertiary paediatric hospital' as one which was accredited for training in both paediatric emergency medicine and paediatric intensive care.
Results:
Of the 1 695 854 paediatric ED presentations, 23.8% were seen in nine major metropolitan tertiary paediatric hospitals. Reasons for presentations were more distinctive between cohorts among children aged 10-14 years, where psychiatric illness (5.2% vs 2.5%) and neurological illness (4.5% vs 2.5%) were more commonly seen in major tertiary paediatric EDs. Australian Indigenous children were significantly less likely to present to tertiary paediatric EDs (3.0%), compared with other EDs (9.7%) (odds ratio 0.27, 95% confidence interval 0.26-0.27). While median waiting times were longer in major tertiary paediatric EDs (28 min [interquartile range 11-65]) than in other EDs (20 min [interquartile range 8-48], P < 0.001), patients were also less likely to leave without being seen (5.5% in tertiary paediatric EDs vs 6.9% in other EDs; odds ratio 0.80, 95% confidence interval 0.78-0.81).
Conclusions:
The present study identified key areas of difference in paediatric presentations between tertiary paediatric EDs and other EDs. It is vital to broaden paediatric ED research beyond tertiary paediatric centres, to ensure relevance and generalisability.
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