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Understanding low acuity emergency department presentations in infancy: A cohort study
Areeb-Ud-Deen Mahmood1,2, Pejman Adily1,3,4, Stephanie Francis5,6
1Community Paediatrics, Sydney Local Health District, Sydney, New South Wales, Australia.
Emergency Medicine Australasia : EMA
|January 19, 2024
Summary
Nearly 20% of infant emergency department visits are low acuity. Interventions should target families facing socioeconomic disadvantage, social isolation, and those with perinatal complications to improve community service engagement.
Area of Science:
- Pediatric Emergency Medicine
- Public Health
- Health Services Research
Background:
- Low acuity presentations (LAPs) represent a significant proportion of emergency department (ED) visits, particularly among infants, leading to substantial healthcare system burden.
- Understanding the characteristics and predictors of infant LAPs is crucial for developing targeted interventions and optimizing resource allocation within pediatric emergency care.
Purpose of the Study:
- To analyze the temporal patterns, discharge diagnoses, and predictive factors associated with low acuity presentations in infants (under 12 months) at a major tertiary hospital.
- To identify demographic, socioeconomic, and perinatal factors that predict both initial and repeat low acuity infant ED visits.
Main Methods:
- A retrospective observational study of 6881 infant ED presentations between 2017 and 2019.
- Descriptive statistics were employed to characterize temporal trends and common diagnoses for LAPs.
- Multivariable logistic regression was used to identify factors associated with low acuity presenters and repeat low acuity presenters (multi-LAPs).
Main Results:
- Infant LAPs constituted 19.8% of all presentations, predominantly occurring on weekdays during business hours (08:00-17:00).
- Common reasons for LAPs included respiratory infections and gastrointestinal complaints, with significant contributions from non-allergic rash, feeding difficulties, and eczema.
- Factors associated with LAPs included socioeconomic status (SES), overseas maternal nationality, and Medicare ineligible maternal financial status. Repeat LAPs were associated with low Apgar scores, low SES, complicated delivery, maternal multiparity, lack of partner presence, and obstetric complications.
Conclusions:
- A considerable proportion of infant ED visits are for low acuity conditions, highlighting a need for improved primary and community care access.
- Interventions should focus on families experiencing socioeconomic disadvantage, social isolation, cultural and linguistic diversity, and those with perinatal complications.
- Strengthening engagement with community-based services is recommended to manage infant LAPs more effectively and reduce ED burden.
