Appropriateness of Pediatric Surgical Consultations From the Emergency Department: A 2-Center Study

BACKGROUND In pediatric emergency departments, increasing patient volume has led to a rising number of consultations, contributing to physician workload, longer hospital stays, and systemic inefficiencies - especially in specialties like pediatric surgery, which faces global shortages in trained professionals. This study aimed to determine the true consultation indication rate between pediatric emergency departments (PED) and pediatric surgery (PS). The study also sought to quantify the consultation-related workload imposed on the PS department by the PED. MATERIAL AND METHODS This retrospective study included 1639 pediatric patients who were referred for PS consultation from the PED of 2 tertiary university hospitals in 2023. The data included patient demographics, consultation timing, preliminary diagnoses, responses, and outcomes. Consultations were categorized based on the justification and time of request. Statistical analysis was conducted using SPSS v25.0, with the significance set at P<0.05. RESULTS We enrolled a total of 1639 (3.1%) out of 52 660 PED patients treated in the 2 centers. Of these, 803 (49%) were deemed appropriate by the PS department, while 836 (51%) were recommended for pediatric evaluation. Surgical intervention was performed in 312 patients (19%) and 326 patients (19.8%) were hospitalized without surgery. Nighttime consultations were significantly more likely to be considered inappropriate (P<.00001), and the most common consultation reasons were abdominal pain/suspected appendicitis (43.3%), foreign body ingestion (9.6%), and trauma (7.1%). CONCLUSIONS This study shows the high rate of inappropriate pediatric surgery consultations, especially during nighttime hours, underscoring the need for improved triage and training. Addressing these issues is essential to enhance clinical efficiency and reduce unnecessary workloads amid the global shortage of pediatric surgeons.