One-year emergency department visits for children < 18 years of age, associated factors and frequency of primary general practitioner or pediatrician visits before: a French observational study (2018-19)

Jeanne Pergeline; Thomas Lesuffleur; Jeanne Fresson; Annick Vilain; Antoine Rachas; Philippe Tuppin

doi:10.1186/s12875-024-02328-1

One-year emergency department visits for children < 18 years of age, associated factors and frequency of primary general practitioner or pediatrician visits before: a French observational study (2018-19)

BMC Prim Care. 2024 Mar 13;25(1):83. doi: 10.1186/s12875-024-02328-1.

Authors

Jeanne Pergeline¹, Thomas Lesuffleur¹, Jeanne Fresson², Annick Vilain², Antoine Rachas¹, Philippe Tuppin³

Affiliations

¹ Direction de la Stratégie, des Etudes et des Statistiques, Caisse nationale de l'assurance maladie, 26-50, Avenue du Professeur André Lemierre, Paris, Cedex 20, 75986, France.
² Direction de la recherche, des études, de l'évaluation et des statistiques, 10 place des cinq martyrs du lycée Buffon, Paris, 75014, France.
³ Direction de la Stratégie, des Etudes et des Statistiques, Caisse nationale de l'assurance maladie, 26-50, Avenue du Professeur André Lemierre, Paris, Cedex 20, 75986, France. philippe.tuppin@assurance-maladie.fr.

Abstract

Background: This study was designed to identify factors associated with at least one emergency department (ED) visit and those associated without consultation by a general practitioner or paediatrician (GPP) before ED visit. Levels of annual consumption of healthcare services as a function of the number of ED visit were reported.

Methods: This retrospective study focused on children < 18 years of age living in mainland France and followed for one-year after their birth or birthday in 2018. Children were selected from the national health data system, which includes data on healthcare reimbursements, long-term chronic diseases (LTD) eligible for 100% reimbursement, and individual complementary universal insurance (CMUc) status granted to households with a low annual income. Adjusted odds ratios (OR) were estimated using multivariate logistic regression.

Results: There were 13.211 million children included (94.2% of children; girls 48.8%). At least one annual ED visit was found for 24% (1: 16%, 2: 5%, 3 or more: 3%) and 14% of visits led to hospitalization. Factors significantly associated with at least one ED visit were being a girl (47.1%; OR = 0.92), age < 1 year (9.1%; OR = 2.85), CMUc (22.7%, OR = 1.45), an ED in the commune of residence (33.3%, OR = 1.15), type 1 diabetes (0.25%; OR = 2.4), epilepsy (0.28%; OR = 2.1), and asthma (0.39%; OR = 2.0). At least one annual short stay hospitalisation (SSH) was found for 8.8% children of which 3.4% after an ED visit. A GPP visit the three days before or the day of the ED visit was found for 19% of children (< 1 year: 29%, 14-17 years: 13%). It was 30% when the ED was followed by SSH and 17% when not. Significant factors associated with the absence of a GPP visit were being a girl (OR = 0.9), age (1 year OR = 1.4, 14-17 years OR = 3.5), presence of an ED in the commune of residence (OR = 1.12), epilepsy LTD (OR = 1.1).

Conclusion: The low level of visits to GPP prior to a visit to the ED and the associated factors are the elements to be taken into account for appropriate policies to limit ED overcrowding. The same applies to factors associated with a visit to the ED, in order to limit daily variations.

Keywords: Administrative claims; Ambulatory healthcare use; Children; Chronic diseases; Emergency service; High users; Hospitalisation.

Publication types

Observational Study

MeSH terms

Child
Emergency Room Visits
Emergency Service, Hospital
Epilepsy*
Female
General Practitioners*
Humans
Infant
Insurance Coverage
Retrospective Studies