Objective-To determine the relation between deprivation category, triage score and accident and emergency (A&E) attendance for children under the age of 13. Design-Retrospective study of all children attending an A&E department over one year. Setting-A paediatric teaching hospital in Edinburgh. Subjects-All children attending the A&E department who had a postcode and a triage score documented on attendance. The postcode was used to determine the deprivation category and the triage scored the severity of illness or injury. Main outcome measure-The relation between deprivation category, triage score and frequency of attendance. Results-There is a trend towards increased attendance in all triage categories for deprivation categories 6 and 7. Conclusions-Attendance at A&E is not only related to severity of injury but also to deprivation category. The reason why people from disadvantaged areas attend more frequently needs further evaluation. (Emerg Med J 2001;18:110-111) Keywords: triage category; deprivation category; child Accident and emergency (A&E) departments nationally are experiencing a year on year rise in workload. The Royal Hospital for Sick Children in Edinburgh (RHSCE) has experienced an increase in attendances from 20 200 in 1992/3, to 29 093 in 1997/8 (an increase of 44%). There are no clear reasons why this workload is increasing either locally or nationally. Recently the issue of deprivation 1 and attendance at A&E has been reported, with factors such as deprivation itself and distance from hospital 2 both being implicated in the rate of attendance. None of these studies have dealt specifically with the paediatric population.Hull et al have highlighted the need for robust markers of variation in need to be developed.3 One such marker could be the triage category of patients presenting to A&E and the purpose of this study is to investigate whether there are variations in the attendance pattern for children from diVerent deprivation groupings by triage category.
Methods and resultsWe examined retrospectively all attendances at the RHSCE from 1 April 1996 to 31 March 1997. Triage categories were changed during the next 12 months to reflect National Triage criteria, making a full year comparison diYcult. The RHSCE is the only paediatric A&E department for Edinburgh City, East Lothian and Midlothian. The department sees and treats all paediatric emergencies for children aged under 13 from these areas. All attendances were coded on attendance (that is, post code) and subsequently linked to both the Carstairs Deprivation Category (DEPCAT) (based on the 1991 census) for deprivation and triage category. 4 The triage category is an objective score allocated on arrival by an experienced registered sick children's nurse for each child attending the A&E department. One of four categories could be allocated on a range from 1 to 4-1 is the most severe and requires urgent and immediate resuscitation: 4 is the least severe and treatment could be delayed in these patients. Indeed many could be seen in prim...
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