Adults in the pediatric emergency department: a fish out of water?

Adults (> 17 years) occasionally seek care in pediatric emergency departments (PED). We reviewed the records of adults treated in our PED from September 1992 to August 1993 to better understand their needs. Patients were classified based on their relationship to our hospital: 1) no previous medical care association (new), and 2) adult patients followed in our clinics for chronic diseases (chronic). Data were analyzed using frequencies and comparison of means by Student's t test or chi 2. A follow-up phone call or written survey was used to assess quality of care and satisfaction. Of 40,895 patients, 384 were adults (0.9%). Ages ranged from 18 to 73 years (median = 21 years, mean = 25 years) with 49% men. Most adults were seen between 3:00 PM and 10:59 PM; 84% were triaged as urgent or emergent. There were 140 new, and 230 chronic, patients. Fourteen were not classified because of lack of information. The mean age of new adults was 33 years, median 29 years; 53% were hospital employees. Forty percent of new adults had preexisting illnesses. Most common problems were cardiac/hypertension (27%), blunt trauma (22%), eye splash (13%), and lacerations (9%). Forty eight percent were transferred to an adult hospital, and 20% of transferred patients were admitted overnight. Chronic adult patients were younger (mean 21 years, P < 0.001); fever/infection (37%), minor trauma (17%), and gastro-intestinal problems (12%) predominated; 36% were admitted. The average time in the PED was 70 minutes for new and 202 minutes for chronic patients (P < 0.001).

Chronic patients present with problems much like those of their younger counterparts, and the PED is prepared to manage them. New adult patients present with adult problems: chest pain, hypertension, blunt trauma, and eye foreign body, and the PED should be prepared to manage these.