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Unfavourable outcome for children leaving the emergency department without being seen by a physician

  • Jocelyn Gravel (a1), Serge Gouin (a1), Benoit Carrière (a1), Nathalie Gaucher (a1) and Benoit Bailey (a1)...

Abstract

Objective:

To assess the prevalence of an unfavourable outcome among children leaving without being seen by a physician in the emergency department (ED).

Method:

This was a prospective cohort study conducted over a complete year in a pediatric tertiary care ED. A random sample of all children younger than 19 years of age who left without being seen by a physician was contacted by phone 4 to 6 days following the ED visit. The primary outcome was the occurrence of an unfavourable outcome prospectively defined using a Delphi method among 15 pediatric emergency physicians. An unfavourable outcome was defined as hospitalization, the need for an invasive procedure (intravenous or intramuscular medication, fracture reduction, bone casting, or surgical intervention), suicide attempt, or death in the 72 hours following leaving without being seen by a physician. As a secondary outcome, multiple potential predictors were evaluated. The first analysis evaluated the proportion of unfavourable outcomes among children who left without being seen by a physician. Then logistic regression identified predictors of unfavourable outcomes.

Results:

During the study period, 61,909 children presented to the ED, 7,592 (12%) left without being seen by a physician, and 1,579 were recruited. Thirty-eight (2.4%; 95% CI 1.7–3.2) patients fulfilled the criteria for an unfavourable outcome. On multiple logistic regression, chief complaints related to trauma and absence of nurse counseling had higher risks of unfavourable outcome.

Conclusions:

Approximately 2% of children who left without being seen by a physician at a tertiary care pediatric ED had an unfavourable outcome.

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Copyright

Corresponding author

Division of Emergency Medicine, Department of Pediatrics, Hôpital Sainte-Justine, Université de Montréal, 3175 Chemin Côte Sainte-Catherine, Montréal, QC H3T 1C5; Graveljocelyn@hotmail.com.

References

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1.Derlet, R, Richards, J, Kravitz, R. Frequent overcrowding in U.S. emergency departments. Acad Emerg Med 2001;8:151–5, doi:10.1111/j.1553-2712.2001.tb01280.x.
2.Taylor, TB. Threats to the health care safety net. Acad Emerg Med 2001;8:1080–7, doi:10.1111/j.1553-2712.2001.tb01119.x.
3.Mohsin, M, Forero, R, Ieraci, S, et al. A population follow-up study of patients who left an emergency department without being seen by a medical officer. Emerg Med J 2007;24:175–9, doi:10.1136/emj.2006.038679.
4.Rowe, BH, Channan, P, Bullard, M, et al. Characteristics of patients who leave emergency departments without being seen. Acad Emerg Med 2006;13:848–52, doi:10.1111/j.1553-2712.2006.tb01735.x.
5.Johnson, M, Myers, S, Wineholt, J, et al. Patients who leave the emergency department without being seen. J Emerg Nurs 2009;35:105–8, doi:10.1016/j.jen.2008.05.006.
6.Gaucher, N, Bailey, B, Gravel, J. Who are the children leaving the emergency department without being seen by a physician? Acad Emerg Med 2011;18:1527, doi:10.1111/j.1553-2712.2010.00989.x.
7.Goldman, RD, Macpherson, A, Schuh, S, et al. Patients who leave the pediatric emergency department without being seen: a case-control study. CMAJ 2005;172:3943.
8.Browne, GJ, McCaskill, ME, Giles, H, et al. Paediatric walk-out patients: characteristics and outcomes. J Paediatr Child Health 2001;37:235–9, doi:10.1046/j.1440-1754.2001.00648.x.
9.Gravel, J, Manzano, S, Arsenault, M. Validity of the Canadian Paediatric Triage and Acuity Scale in a tertiary care hospital. CJEM 2009;11:23–8.
10.Hung, GR, Chalut, D. A consensus-established set of important indicators of pediatric emergency department performance. Pediatr Emerg Care 2008;24:915.
11.Alessandrini, E, Varadarajan, K, Alpern, ER, et al. mergency department quality: an analysis of existing pediatric measures. Acad Emerg Med 2011;18:519–26, doi:10.1111/j.1553-2712.2011.01057.x.
12.dos Santos, LM, Stewart, G, Rosenberg, NM. Pediatric emergency department walk-outs. Pediatr Emerg Care 1994;10:76–8, doi:10.1097/00006565-199404000-00003.
13.Kronfol, RN, Childers, K, Caviness, AC. Patients who leave our emergency department without being seen: the Texas Children’s Hospital experience. Pediatr Emerg Care 2006;22:550–4, doi:10.1097/01.pec.0000230554.01917.cb.
14.Kennedy, M, MacBean, CE, Brand, C, et al. Review article: leaving the emergency department without being seen. Emerg Med Australas 2008;20:306–13, doi:10.1111/j.1742-6723.2008.01103.x.
15.Warren, DW, Jarvis, A, LeBlanc, L, et al. Revisions to the Canadian Triage and Acuity Scale paediatric guidelines (PaedCTAS). CJEM 2008;10:224–43.
16.Cialkowska, M, Adamowski, T, Piotrowski, P, et al. [What is the Delphi method? Strengths and shortcomings]. Psychiatr Pol 2008;42:515.
17.Jones, J, Hunter, D. Consensus methods for medical and health services research. BMJ 1995;311:376–80, doi:10.1136/bmj.311.7001.376.
18.Rothman, KJ. No adjustments are needed for multiple comparisons. Epidemiology 1990;1:43–6, doi:10.1097/00001648-199001000-00010.
19.Monzon, J, Friedman, SM, Clarke, C, et al. Patients who leave the emergency department without being seen by a physician: a control-matched study. CJEM 2005;7:107–13.
20.Guttmann, A, Schull, MJ, Vermeulen, MJ, et al. Association between waiting times and short term mortality and hospital admission after departure from emergency department: population based cohort study from Ontario, Canada. BMJ 2011;342:d2983, doi:10.1136/bmj.d2983.
21.Gaucher, N, Bailey, B, Gravel, J. For children leaving the emergency department before being seen by a physician, counseling from nurses decreases return visits. Int Emerg Nurs 2011;19:173–7, doi:10.1016/j.ienj.2011.03.002.
22.Gravel, J, Gouin, S, Goldman, RD, et al. The Canadian Triage and Acuity Scale for children: a prospective multicenter evaluation. Ann Emerg Med 2012;60:71–7, doi:10.1016/annemergined.2011.12.004.

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