Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-28T01:23:26.752Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  04 March 2015

Jocelyn Gravel ,
Serge Gouin ,
Benoit Carrière ,
Nathalie Gaucher  and
Benoit Bailey
Jocelyn Gravel*
Affiliation:
Division of Emergency Medicine, Department of Pediatrics, Hôpital Sainte-Justine, Université de Montréal, Montréal, QC
Serge Gouin
Affiliation:
Division of Emergency Medicine, Department of Pediatrics, Hôpital Sainte-Justine, Université de Montréal, Montréal, QC
Benoit Carrière
Affiliation:
Division of Emergency Medicine, Department of Pediatrics, Hôpital Sainte-Justine, Université de Montréal, Montréal, QC
Nathalie Gaucher
Affiliation:
Division of Emergency Medicine, Department of Pediatrics, Hôpital Sainte-Justine, Université de Montréal, Montréal, QC
Benoit Bailey
Affiliation:
Division of Emergency Medicine, Department of Pediatrics, Hôpital Sainte-Justine, Université de Montréal, Montréal, QC
*
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.

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
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.

Keywords

childrenemergency departmentleft without being seentriage
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 15 , Issue 5 , September 2013 , pp. 289 - 299
Copyright
Copyright © Canadian Association of Emergency Physicians 2013

References

REFERENCES

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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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;172:39–43.Google Scholar
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.Google Scholar
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.Google Scholar
10.Hung, GR, Chalut, D. A consensus-established set of important indicators of pediatric emergency department performance. Pediatr Emerg Care 2008;24:9–15.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
16.Cialkowska, M, Adamowski, T, Piotrowski, P, et al. [What is the Delphi method? Strengths and shortcomings]. Psychiatr Pol 2008;42:5–15.Google Scholar
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.Google Scholar
18.Rothman, KJ. No adjustments are needed for multiple comparisons. Epidemiology 1990;1:43–6, doi:10.1097/00001648-199001000-00010.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar