Understanding low acuity emergency department presentations in infancy: A cohort study

Areeb-Ud-Deen Mahmood; Pejman Adily; Stephanie Francis; John Eastwood; Kendall Bein; Bashir A Chakar; Alicia Montgomery

doi:10.1111/1742-6723.14364

Understanding low acuity emergency department presentations in infancy: A cohort study

Emerg Med Australas. 2024 Jan 18. doi: 10.1111/1742-6723.14364. Online ahead of print.

Authors

Areeb-Ud-Deen Mahmood^{1

2}, Pejman Adily^{1

3

4}, Stephanie Francis^{5

6}, John Eastwood^{1

7}, Kendall Bein^{5

8}, Bashir A Chakar^{5

8}, Alicia Montgomery^{1

4

8

9}

Affiliations

¹ Community Paediatrics, Sydney Local Health District, Sydney, New South Wales, Australia.
² UNSW Faculty of Medicine and Health, Sydney, New South Wales, Australia.
³ Ingham Institute of Medical Research, Sydney, New South Wales, Australia.
⁴ Database Manager for The Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, Australia.
⁵ Royal Prince Alfred Hospital, Emergency Department, Sydney, New South Wales, Australia.
⁶ UNSW School of Women's and Children's Health, Sydney, New South Wales, Australia.
⁷ Southern District Health Board, South Island, New Zealand.
⁸ RPA Greenlight Institute for Emergency Care, Sydney, New South Wales, Australia.
⁹ UNSW School of Psychiatry, Sydney, New South Wales, Australia.

PMID: 38239022
DOI: 10.1111/1742-6723.14364

Abstract

Objective: Low acuity presentations (LAPs) contribute to large numbers of ED presentations and carry numerous consequences. The present study sought to improve the understanding of regional infant LAPs by analysing temporal patterns of presentation, discharge diagnoses and potential predictive factors.

Methods: This retrospective observational study examined ED presentations among children less than 12 months old (infants) to the Royal Prince Alfred Hospital between 2017 and 2019. Descriptive statistics were used to identify temporal patterns of presentation and common discharge diagnoses among LAPs. Multivariable logistic regression was used to determine the association between early life, demographic and perinatal factors and low acuity presenters.

Results: Of 6881 infant ED presentations, 19.8% were LAPs, occurring disproportionately on weekdays (82.2%) and during hours of 08.00-17.00 (69.9%). Respiratory tract infections and gastrointestinal complaints were most common overall, though non-allergic rash, feeding difficulties, eczema and developmental concerns contributed substantially among LAPs. Socio-economic status (SES) (odds ratio [OR] 1.71), overseas maternal nationality (OR 1.25) and Medicare ineligible maternal financial class (OR 0.49) were associated with low acuity presenters. Low appearance, pulse, grimace, activity and respiration score (OR 3.53), low SES (OR 3.26), complicated delivery (OR 1.64), maternal multiparity (OR 0.50), maternal partner presence (OR 0.40) and obstetric complications (OR 0.37) were associated with repeat, multi-low acuity presenters (multi-LAPs).

Conclusion: A substantial minority of infant ED presentations are LAPs. Targeted interventions may benefit from focusing on families with a background of socioeconomic disadvantage, social isolation, cultural and linguistic diversity and perinatal complications, with a view to strengthening engagement with community-based services among these groups.

Keywords: infant; low acuity presentation; predictor.