Where are children seen in Australian emergency departments? Implications for research efforts

Jolene Cj Lim; Meredith L Borland; Paul M Middleton; Katie Moore; Amith Shetty; Franz E Babl; Robert S Lee; Jason Acworth; Catherine Wilson; Martin Than; Simon Craig; ACEM EDEN and the PREDICT Network

doi:10.1111/1742-6723.13698

Where are children seen in Australian emergency departments? Implications for research efforts

Emerg Med Australas. 2021 Aug;33(4):631-639. doi: 10.1111/1742-6723.13698. Epub 2021 Jan 3.

Authors

Jolene Cj Lim¹, Meredith L Borland^{2

3}, Paul M Middleton^{4

5

6

7

8}, Katie Moore¹, Amith Shetty^{5

9

10}, Franz E Babl^{11

12

13}, Robert S Lee¹, Jason Acworth^{14

15}, Catherine Wilson¹³, Martin Than^{5

16}, Simon Craig^{5

13

17

18}; ACEM EDEN and the PREDICT Network

Affiliations

¹ Policy and Research Division, Department of Policy and Strategic Partnerships, Australasian College for Emergency Medicine, Melbourne, Victoria, Australia.
² Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.
³ Divisions of Emergency Medicine and Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia.
⁴ South Western Emergency Research Institute, Ingham Institute, Liverpool Hospital, Sydney, New South Wales, Australia.
⁵ Emergency Department Epidemiology Network, Australasian College for Emergency Medicine, Melbourne, Victoria, Australia.
⁶ South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.
⁷ MARCS Institute, Western Sydney University, Sydney, New South Wales, Australia.
⁸ Emergency Medicine, The University of Sydney, Sydney, New South Wales, Australia.
⁹ Emergency Department, NSW Ministry of Health, Westmead Hospital, Sydney, New South Wales, Australia.
¹⁰ Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.
¹¹ Department of Paediatrics and Centre of Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.
¹² Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.
¹³ Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
¹⁴ Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
¹⁵ Emergency Department, Queensland Children's Hospital, Brisbane, Queensland, Australia.
¹⁶ Emergency Department, Christchurch Hospital, Christchurch, New Zealand.
¹⁷ Emergency Department, Monash Medical Centre, Emergency Program, Monash Health, Melbourne, Victoria, Australia.
¹⁸ Department of Paediatrics, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.

PMID: 33393221
DOI: 10.1111/1742-6723.13698

Abstract

Objective: With most paediatric emergency research in Australia conducted at tertiary EDs, it is important to understand how presentations differ between those at tertiary paediatric EDs and all other EDs.

Methods: Retrospective epidemiological study assessing paediatric case-mix and time-based performance metrics (aged 0-14 years) obtained from a national health service minimum dataset for the 2017-2018 financial year, comparing tertiary paediatric EDs and all other EDs. We defined a 'major tertiary paediatric hospital' as one which was accredited for training in both paediatric emergency medicine and paediatric intensive care.

Results: Of the 1 695 854 paediatric ED presentations, 23.8% were seen in nine major metropolitan tertiary paediatric hospitals. Reasons for presentations were more distinctive between cohorts among children aged 10-14 years, where psychiatric illness (5.2% vs 2.5%) and neurological illness (4.5% vs 2.5%) were more commonly seen in major tertiary paediatric EDs. Australian Indigenous children were significantly less likely to present to tertiary paediatric EDs (3.0%), compared with other EDs (9.7%) (odds ratio 0.27, 95% confidence interval 0.26-0.27). While median waiting times were longer in major tertiary paediatric EDs (28 min [interquartile range 11-65]) than in other EDs (20 min [interquartile range 8-48], P < 0.001), patients were also less likely to leave without being seen (5.5% in tertiary paediatric EDs vs 6.9% in other EDs; odds ratio 0.80, 95% confidence interval 0.78-0.81).

Conclusions: The present study identified key areas of difference in paediatric presentations between tertiary paediatric EDs and other EDs. It is vital to broaden paediatric ED research beyond tertiary paediatric centres, to ensure relevance and generalisability.

Keywords: case-mix; emergency presentation; health service research; paediatric; time performance.

MeSH terms

Australia
Child
Emergency Service, Hospital*
Hospitals, Pediatric
Humans
Retrospective Studies
State Medicine*