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Average visit rate according to age (in years). This graph demonstrates the average number of visits according to age. One-year-old children show the highest number of recurrent visits. Age is inversely correlated with the number of recurrent visits.
Source publication
Objectives
The number of paediatric patients visiting the emergency department (ED) continues to rise. In South Korea, approximately 25% of the patients who visit the ED are paediatric patients. In the USA, about 20% of the paediatric population were found to have visited the ED in the past year. A recent study demonstrated that 4.5%–8% of patients...
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Objective:
Distal forearm fractures are among the most common upper limb fractures in all ages, and many classifications have been proposed to describe them. Recently, a new version of AO/OTA classification was proposed. The aim of this study is to use the AO/OTA 2018 classification to report the epidemiology of distal forearm fractures in adults...
Citations
... Four studies [23][24][25][26] were conducted in EMS settings, of which three 24-26 used all EMS contacts via telephone and one 23 examined ED conveyance. Eight studies [27][28][29][30][31][32][33][34] were conducted using ED data with arrivals via EMS or ambulance as inclusion criterion. All 12 studies were conducted retrospectively and none followed an interventional design. ...
... Three of the eight ED studies [28][29][30] identified that frequent ED use was associated with an increased usage of EMS. For instance, Gibson et al, 28 a multicentre study with nine sites conducted in Australia, identified that among those attending the ED 10-19 times per year, arrival was via ambulance in 10.4% of attendances as opposed to 5.6% among the non-frequent attenders. ...
Background
Frequent use of emergency medical services (EMS) is recognised to be a global phenomenon, although paediatric frequent use is poorly understood. This systematic review aimed to understand how paediatric frequent use of EMS is currently defined, identify factors associated with paediatric frequent use of EMS and determine effectiveness of interventions for paediatric patients who frequently use EMS.
Methods
Four electronic databases (Medline, CINAHL, Web of Science and PsycINFO) were searched to September 2022 for primary, peer-reviewed research studies published in English from January 2000. Studies were included that examined frequent use (>1 contact during study period) of EMS or other services with arrival via EMS. Paediatric patients were defined as <18 years of age or otherwise defined by study authors as paediatric/adolescent/children. Data were extracted using a structured proforma, and quality was assessed using the Standard Quality Assessment Criteria for Quantitative Studies but did not influence inclusion decisions. Data were presented using narrative synthesis.
Results
The search resulted in 4172 unique references, with 12 papers included in the review from 7 countries. Four were EMS studies, and eight Emergency Department with arrival via EMS. All studies used retrospective designs, with no interventional studies identified. Paediatric frequent EMS users were more likely to use services for medical reasons rather than trauma, including respiratory complaints, mental health and seizures, but data on gender and ethnicity were inconclusive and silent on socioeconomic status. There was no consistency in definitions of either a paediatric patient or of frequent use.
Conclusion
The broad range of reasons for frequent use suggests that a single intervention is unlikely to be effective at addressing the causes of frequent use. There is a need for further research to better identify the underlying reasons for frequent EMS use among paediatric patients and to develop interventions in this population.
... Similarly, increasing preventive measures for communicable diseases will help to decrease the cost of ED services. However, using tertiary ED services for primary care is a problem regardless of refugee status [36,37]. Appropriate early management of minor illnesses related to respiratory and gastrointestinal system diseases in the primary care settings will prevent admissions related to ambulatory-caresensitive conditions in the ED for both resident and refugee children. ...
Evaluation of emergency department (ED) presentation by Syrian refugee children might provide important information about their health care needs. For this purpose, we compared ED presentation of refugee and resident children in a tertiary university hospital in Istanbul, Turkey.Electronic medical records of Syrian refugee children ≤ 18 years old presenting to the ED between January 2013 and July 2019 were retrospectively reviewed and compared with resident children.The study population consisted of 7299 refugees and 690,127 resident children admitted to the ED. High-acuity cases were more frequent in Syrian refugees (2.2% vs 1% p < 0.001). One-third of Syrian children were under 12 months of age (31% vs 17%, p < 0.001). Syrian children were more commonly hospitalized (7.9% vs 3.1% p < 0.001). The median age (and interquartile range – IQR) was lower in hospitalized refugee than in resident children [12 (0–83) months vs 41 (8–111) months, p < 0.001]. Rate of intensive care unit hospitalization (13% vs 9.4%, p = 0.001) and neonatal hospitalization was higher in Syrians compared to resident children (29% vs 12%, p < 0.001). The median NICU stay was longer in refugees [6 (IQR 4–17) days vs 3 (IQR 1–9) days, p < 0.001].Conclusion: Refugee children, as compared to resident children, are more likely to present to the ED with high acuity conditions and at a younger age resulting in higher rates of inpatient admissions. Strategies to increase access to preventive health care services for young refugee children should be explored to decrease ED and hospital services and improve health outcomes.
What is Known:
• Children are the most affected victims of armed conflicts in terms of health outcomes.
• Refugees prefer to access healthcare through the emergency department.
What is New:
• Refugee children were more likely to present as urgent when compared to resident children.
• Admission to neonatal and intensive care units was more frequent among refugee than resident children.
... Consequently, the underlying threshold value needs to be specified with extreme caution. Last but not least, our results validate something similar to the Pareto principle argued in [46]: "A small portion of ER users are responsible for a disproportionate utilization of these services compared to the rest of the population. These "frequent users", whose first point of medical contact is the ED, include individuals of lower socioeconomic status (typically indigent people seeking primary care)". ...
We analyze a congested healthcare delivery setting resulting from emergency treatment of a chronic disease on a regular basis. A prominent example of the problem of interest is congestion in the emergency room (ER) at a publicly funded safety net hospital resulting from recurrent arrivals of uninsured end-stage renal disease patients needing dialysis (a.k.a. compassionate dialysis). Unfortunately, this is the only treatment option for un/under-funded patients (e.g., undocumented immigrants) with ESRD, and it is available only when the patient’s clinical condition is deemed as life-threatening after a mandatory protocol, including an initial screening assessment in the ER as dictated and communicated by hospital administration and county policy. After the screening assessment, the so-called treatment restrictions are in place, and a certain percentage of patients are sent back home; the ER, thus, serves as a screening stage. The intention here is to control system load and, hence, overcrowding via restricting service (i.e., dialysis) for recurrent arrivals as a result of the chronic nature of the underlying disease. In order to develop a deeper understanding of potential unintended consequences, we model the problem setting as a stylized queueing network with recurrent arrivals and restricted service subject to the mandatory screening assessment in the ER. We obtain analytical expressions of fundamental quantitative metrics related to network characteristics along with more sophisticated performance measures. The performance measures of interest include both traditional and new problem-specific metrics, such as those that are indicative of deterioration in patient welfare because of rejections and treatment delays. We identify cases for which treatment restrictions alone may alleviate or lead to severe congestion and treatment delays, thereby impacting both the system operation and patient welfare. The fundamental insight we offer is centered around the finding that the impact of mandatory protocol on network characteristics as well as traditional and problem-specific performance measures is nontrivial and counterintuitive. However, impact is analytically and/or numerically quantifiable via our approach. Overall, our quantitative results demonstrate that the thinking behind the mandatory protocol is potentially naive. This is because the approach does not necessarily serve its intended purpose of controlling system-load and overcrowding.
... A similar age distribution in pediatric emergency department visits was seen in other parts of the world. A Californian and a Korean study both showed frequent visits to emergency departments were more common in children aged 1 to 4 years [30,31]. However, these studies did not detail if asylumseeking children were included. ...
Background
Asylum-seeking children represent an increasing and vulnerable group of patients whose health needs are largely unmet. Data on the health care provision to asylum-seeking children in European contexts is scarce. In this study we compare the health care provided to recent asylum-seeking and non-asylum-seeking children at a Swiss tertiary hospital.
Methods
We performed a cross-sectional retrospective study in a pediatric tertiary care hospital in Basel, Switzerland. All patients and visits from January 2016 to December 2017 were identified, using administrative and medical electronic health records. The asylum-seeking status was systematically assessed and the patients were allocated accordingly in the two study groups.
Results
A total of 202,316 visits by 55,789 patients were included, of which asylum-seeking patients accounted for 1674 (1%) visits by 439 (1%) individuals. The emergency department recorded the highest number of visits in both groups with a lower proportion in asylum-seeking compared to non-asylum-seeking children: 19% (317/1674) and 32% (64,315/200,642) respectively. The median number of visits per patient was 1 (IQR 1–2) in the asylum-seeking and 2 (IQR 1–4) in the non-asylum-seeking children. Hospital admissions were more common in asylum-seeking compared to non-asylum-seeking patients with 11% (184/1674) and 7% (14,692/200,642). Frequent visits (> 15 visits per patient) accounted for 48% (807/1674) of total visits in asylum-seeking and 25% (49,886/200,642) of total visits in non-asylum-seeking patients.
Conclusions
Hospital visits by asylum-seeking children represented a small proportion of all visits. The emergency department had the highest number of visits in all patients but was less frequently used by asylum-seeking children. Frequent care suggests that asylum-seeking patients also present with more complex diseases. Further studies are needed, focusing on asylum-seeking children with medical complexity.
... Consequently, the underlying threshold value needs to be specified with extreme caution. Last but not least, our results validate something similar to the Pareto principle argued in [46]: "A small portion of ER users are responsible for a disproportionate utilization of these services compared to the rest of the population. These "frequent users", whose first point of medical contact is the ED, include individuals of lower socioeconomic status (typically indigent people seeking primary care)". ...
... In a recent multicenter study, fever was the most common complaint for children revisiting the emergency department (ED) within 3 days (12). Fever primarily presents as a symptom of viral infection but can also be a sign of occult bacterial infection in 1.5-2% ED patients (13). ...
... Of those, 54 (0.03%) patients met the inclusion criteria and were included as the study group; the mean age was 1.9 ± 0.45 years, and 66.7% of them were male ( Table 2). The median PRISM score during the 24 h of admission was 7 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). Three (5.6%) of the patients expired during admission, and six patients (11.1%) required mechanical ventilator (MV) support. ...
... In this study, we demonstrated an ICU admission rate of 0.5% following unplanned return visits, primarily of the male gender, which was similar to previous studies regarding the pediatric population (ranging from 0.4 to 0.7%) (8,26). With a mean age of 1.9 ± 0.45 years for the included patients, we further separated them into five different age brackets for the selected comparison group since the likelihood of return visits varied with age intervals (12,27). Upon comparing the ICU admission and non-ICU admission groups, we found that time was one of the key points in determining risk factors. ...
Objective: The purpose of this article was to demonstrate related characteristics of intensive care unit (ICU) admission after an unscheduled revisit by febrile children visiting the emergency department (ED).
Method: We performed a retrospective study in a tertiary medical center from 2010 to 2016. Patients whose chief complaint was fever and who were admitted to the ICU following a 72-h return visit to the ED were included, and we selected patients who were discharged from the same emergency department for comparison.
Results: During the study period, 54 (0.03%) patients met the inclusion criteria, and 216 patients were selected for the matched control group. Regarding clinical variables on initial ED visit, visiting during the night shift (66.7 vs. 46.8%, p = 0.010), shorter length of 1st ED stay (2.5 ± 2.63 vs. 3.5 ± 3.44 h, p = 0.017), and higher shock index (SI) (1.6 ± 0.07 vs. 1.4 ± 0.02, p = 0.008) were associated with ICU admission following a return visit. On the return ED visit, we found that clinical variables such as elevated heart rate, SI, white blood cell count, and C-reactive protein level were all associated with ICU admission. Furthermore, elevated SI and pediatric age-adjusted (SIPA) values were observed in the study group in both the initial (42.2 vs. 20.1%, OR:2.3 (1.37–4.31), p = 0.002) and return ED visits (29.7 vs. 6.9%, OR: 4.6 (2.42–8.26), p < 0.001).
Conclusion: For children who visited the emergency department with a febrile complaint, elevated SIPA values on the initial ED visit were associated with ICU admission following an unscheduled ED revisit within 72 h.
... [22] Pediatric patients tended to visit the ED for low acuity complaints such as respiratory and gastrointestinal disorder, and fever, which were consistent with previous studies. [23,24] Because of these different www.md-journal.com Table 1 Demographics of frequent and occasional ED users at the first visit. ...
Emergency department (ED) crowding is a public health burden that impedes the provision of high-quality emergency care and is related to poor outcomes. Frequent ED visits are known to contribute to ED crowding. This study aimed to identify frequent ED users’ characteristics and risk factors related to frequent ED visits.
A retrospective observational study was conducted using ED-based data derived from adult patients at a university hospital. The main exposure variable was frequent ED visits, which were defined as ≥4 visits within 12 months (January 1–December 31, 2018). Characteristics and risk factors for frequent ED users were evaluated using stepwise regression analysis.
Within the study period, there were 36,932 ED visits involving 29,759 patients. Of these, 3031 (8.2%) visits were from 556 (1.9%) patients classified as frequent ED users. The independent risk factors for frequent ED visits were older patients (≥65 years); the winter season; daytime discharge from ED; patients with medical aid insurance; and patients designated as high acuity at their first visit. Patients with a malignant neoplasm, mental health disorder, alcohol-related liver disease, chronic kidney disease, or chronic obstructive pulmonary disease were associated with more frequent ED visits.
Frequent ED users comprised a significant proportion of total ED visits. Frequent ED users were more likely than occasional ED users to be in poorer health, older, or have a chronic disease or a mental health disorder.
... It may also result in increased numbers of presentations with non-urgent conditions at emergency departments. There is a global trend of an increase in non-urgent visits at emergency departments in high-income countries, which could also potentially be prevented by primary health care [18][19][20][21]. Asylum-seeking children are at risk of lacking integration into the primary health care system and may therefore have higher rates of ambulatory-care-sensitive admissions and non-urgent emergency-department presentations than their local peers. ...
... This proportion is considerably higher than in previous reports of 30-40% of non-urgent visits in pediatric emergency care centers in Canada and Australia [19,34], 40% in Belgium and Italy [35,36] and 60% in the United States [37] . However, the tendency to provide primary care by tertiary health care institutions is described as global problem and one reason for growing health expenses [20]. In a study from the UK, no association between non-urgent presentations and the asylum-status was found [38]. ...
Background:
Migrant health has become an essential part of public health. According to the World Health Organization, many health systems in Europe have not yet adapted adequately to the needs of asylum-seekers, which might result in untimely and inefficient health care for asylum-seeking patients. The aim of this study was to assess the number of preventable hospital admissions and emergency department visits in asylum-seeking and non-asylum-seeking pediatric patients.
Methods:
This is a retrospective, hospital-based study. The study was done at the University Children's Hospital Basel in Switzerland. Patients admitted or presenting to the emergency department were included and split into the groups of asylum-seeking and non-asylum-seeking patients. All admissions and emergency-department visits were extracted from the administrative electronic health records from 1st Jan 2016-31st Dec 2017. The main outcome was the proportion of admissions due to ambulatory-care-sensitive conditions (which refer to conditions for which admission can be prevented by early interventions in primary care) in asylum-seeking and non-asylum-seeking patients. Ambulatory-care-sensitive conditions were defined by a validated list of ICD-10 codes. The secondary objective was to assess the number of preventable emergency-department visits by asylum-seeking patients defined as proportion of visits with a non-urgent triage score.
Results:
A total of 75'199 hospital visits were included, of which 63'405 were emergency department visits and 11'794 were admissions. Ambulatory-care-sensitive conditions accounted for 12.1% (18/149) of asylum-seeking and 10.9% (1270/11645) of non-asylum seeking patients' admissions. Among the emergency department visits by asylum-seeking patients, non-urgent conditions accounted for 82.2% (244/297).
Conclusions:
Admissions due to ambulatory-care-sensitive conditions are comparable in asylum-seeking and non-asylum-seeking children, suggesting few delayed presentations to ambulatory care facilities. Strategies to prevent non-urgent visits at pediatric emergency department facilities are needed.
... A similar age distribution in pediatric emergency department visits was seen in other parts of the world. A Californian and a Korean study both showed frequent visits to emergency departments were more common in children aged 1 to 4 years [31,32]. However, these studies did not detail if asylum-seeking children were included. ...
Background
Asylum-seeking children represent an increasing and vulnerable group of patients whose health needs are largely unmet. Data on the health care provision to asylum-seeking children in European contexts is scarce. In this study we compare the health care provided to recent asylum-seeking and non-asylum-seeking children at a Swiss tertiary hospital.Methods
We performed a cross-sectional retrospective study in a pediatric tertiary care hospital in Switzerland. All patients and visits from January 2016 to December 2017were identified, using administrative and medical electronic health records. The asylum-seeking status was systematically assessed and the patients were allocated accordingly in the two study groups.Results A total of 202’316 visits by 55’789 patients were included, of which asylum-seeking patients accounted for 1674 (1%) visits by 439 (1%) individuals. The emergency department recorded the highest number of visits in both groups with a lower proportion in asylum-seeking compared to non-asylum-seeking children: 19% (317/1674) and 32% (64’315/200’642) respectively. The median number of visits per patient was 1 (IQR 1-2) in the asylum-seeking and 2 (IQR 1-4) in the non-asylum-seeking children. Hospital admissions were more common in asylum-seeking compared to non-asylum-seeking patients with 11% (184/1674) and 7% (14’692/200’642). Frequent visits (>15 visits per patient) accounted for 48% (807/1674) of total visits in asylum-seeking and 25% (49’886/200’642) of total visits in non-asylum-seeking patients. Conclusions
Hospital visits by asylum-seeking children represented a small proportion of all visits. The emergency department had the highest number of visits in all patients but was less frequently used by asylum-seeking children. Frequent care suggests that asylum-seeking patients also present with more complex diseases. Further studies are needed, focusing on asylum-seeking children with medical complexity.
... A similar age distribution in pediatric emergency department visits was seen in other parts of the world. A Californian and a Korean study both showed frequent visits to emergency departments were more common in children aged 1 to 4 years [30,31]. However, these studies did not detail if asylum-seeking children were included. ...
Background
Asylum-seeking children represent an increasing and vulnerable group of patients whose health needs are largely unmet. Data on the health care provision to asylum-seeking children in European contexts is scarce. In this study we compare the health care provided to recent asylum-seeking and non-asylum-seeking children at a Swiss tertiary hospital.Methods
We performed a cross-sectional retrospective study in a pediatric tertiary care hospital in Basel, Switzerland. All patients and visits from January 2016 to December 2017 were identified, using administrative and medical electronic health records. The asylum-seeking status was systematically assessed and the patients were allocated accordingly in the two study groups.Results A total of 202,316 visits by 55,789 patients were included, of which asylum-seeking patients accounted for 1674 (1%) visits by 439 (1%) individuals. The emergency department recorded the highest number of visits in both groups with a lower proportion in asylum-seeking compared to non-asylum-seeking children: 19% (317/1674) and 32% (64,315/200,642) respectively. The median number of visits per patient was 1 (IQR 1-2) in the asylum-seeking and 2 (IQR 1-4) in the non-asylum-seeking children. Hospital admissions were more common in asylum-seeking compared to non-asylum-seeking patients with 11% (184/1674) and 7% (14,692/200,642). Frequent visits (>15 visits per patient) accounted for 48% (807/1674) of total visits in asylum-seeking and 25% (49,886/200,642) of total visits in non-asylum-seeking patients. Conclusions
Hospital visits by asylum-seeking children represented a small proportion of all visits. The emergency department had the highest number of visits in all patients but was less frequently used by asylum-seeking children. Frequent care suggests that asylum-seeking patients also present with more complex diseases. Further studies are needed, focusing on asylum-seeking children with medical complexity.
