Healthcare utilisation patterns for paediatric functional somatic symptom presentation: a 3-year retrospective...

Children and young persons frequently present to Emergency Departments (EDs) with physical symptoms lacking a clear medical cause, often reflecting underlying psychosocial distress. Such presentations are associated with repeated healthcare use, specialist referrals, and avoidable costs, yet longitudinal evidence on healthcare trajectories and cost patterns across care settings remains limited, particularly in Asian contexts. This study characterised three-year healthcare utilisation and associated costs among children and young persons presenting with possible functional somatic symptoms to a paediatric ED in Singapore, and identified factors associated with recurrent ED use.

We conducted a retrospective cohort study using de-identified electronic medical records from a tertiary paediatric hospital. Patients aged 6-15 years who presented to the ED in 2018 with predefined indicators of functional somatic symptom were followed for three years from their index visit (2018 to 2021), with annual tracking of ED, inpatient, and specialist outpatient care (SOC) use. Descriptive analyses summarised healthcare use and costs, and logistic regression examined factors associated with recurrent ED visits beyond Year 1.

Among 4,964 unique patients, ED re-visits declined by 84.5% and total healthcare costs dropped by 75.6% from Year 1 to Year 3. While most patients in Year 1 were treated and discharged (39.9%), SOC referrals (31.1% in Year 2; 35.6% in Year 3) and inpatient admissions (26.4% in Year 2; 30.7% in Year 3) remained substantial in the following years. Younger age, minority ethnicity, and initial inpatient admission were associated with higher odds of recurrent ED visits beyond Year 1.

Despite declining ED re-visits over time, persistent specialist outpatient and inpatient use suggests unresolved psychosocial needs in a subset of patients. Younger age, minority ethnicity, and initial inpatient admission identified subgroups at higher risk of recurrent ED use. These findings support the integration of systematic psychosocial screening and culturally responsive referral pathways across care settings to reduce avoidable healthcare utilisation and address underlying distress in this population.