Paediatric frequent attenders at emergency departments: a linked-data population study

Abstract

Aim: To characterise the phenomena of paediatric frequent attenders (FAs) to emergency departments (EDs) in Perth.

Methods: A linked data population study of all children (<15 years) attending Perth hospital EDs between 1 July 2000 and 31 December 2006. FAs attending five or more times annually were assessed for demographic characteristics, mode of arrival, urgency, clinical conditions and disposition by frequency of attendance.

Results: Over 6.5 years, 229, 883 children contributed to 378, 068 annualised chains of events (mean 1.5). Most children (98.2%) attended EDs less than five times a year. The more frequently children attended, the more likely they were to be male, younger, self-referred, have respiratory or infectious disorders, and to arrive by ambulance. Characteristics of those attending 0-4 (n= 371 171) and 5-9 (n= 6405) times per year were broadly similar, while those attending 10-19 times per year (n= 461) were more urgent, had a higher frequency of respiratory disease and higher admission rates (all P < 0.001). Those attending more than 20 times a year (n= 31) had serious chronic illness.

Conclusions: Frequent attenders of 5-9 times a year may be no sicker or more in need of hospital services than those who attend less frequently. The preponderance of respiratory and infectious disorders across all FA groups suggests these could be the focus of further research. We advocate a holistic approach to take into account parental expectations, and a systems approach to change ED attendance behaviour.