Characteristics of paediatric frequent presenters at emergency departments: A whole‐of‐population study

Abstract

Aim To quantify the frequency of emergency department (ED) presentations and profile the socio‐demographic, health and presentation characteristics of paediatric ED frequent presenters. Methods A population‐based data linkage study of 55 921 children in the South Australian Early Childhood Data Project aged 0–12 years with 100 976 presentations to public hospital EDs in South Australia. For each child, the total number of recurrent ED presentations during a 364‐day period post‐index presentation was calculated. Frequent presenters were children who experienced ≥4 recurrent ED presentations. We determined the socio‐demographic, health and presentation characteristics by number of recurrent presentations. Results Children with ≥4 recurrent presentations (4.4%) accounted for 15.4% of all paediatric ED presentations and 22.5% of subsequent admissions to hospital during the 12‐month study period. Compared to children with no recurrent ED presentation, frequent presenters had higher proportions of socio‐economic and health disadvantage at birth. One in two (49.3%) frequent presenters had at least one injury presentation and one (21.3%) in five had at least one presentation related to a chronic condition. Conclusions Children with ≥4 presentations do not represent the majority of ED users. Nevertheless, they represent a disproportionate burden accounting for 15% of all paediatric ED presentations in a 12‐month period. Frequent presenters were characterised by early socio‐economic and health disadvantage, and childhood injury. Strategies targeting social disadvantage and childhood injury may reduce the burden of ED presentations.

The Hospital Burden Associated With Intergenerational Contact With the Welfare System in Australia

“…While welfare receipt has been associated with poorer mental health outcomes, 11 , 29 , 31 , 34 our study showed individuals with IWC experienced even higher mental health hospitalization rates compared with individuals with WC experienced only in 1 generation. We expected individuals with IWC to have higher injury hospitalization rates, given injury hospitalization is more frequent in individuals from disadvantaged backgrounds 45 , 46 but this had not been quantified. Individuals with IWC having higher hospitalization rates related to pregnancy and childbirth reflects the inclusion of welfare payments associated with parenting.…”

“… 45 Primary diagnosis codes used to identify pediatric Complex Chronic Conditions (CCCs) were adapted to the ICD-10-AM coding. 46 …”

Can social risks in early life predict children’s health and academic outcomes? An analysis of the Longitudinal Study of Australian Children

“…To confirm that social risk is a reasonable predictor of poor academic achievement, a more definitive measure of academic performance could be used, such as highest level of academic attainment, although such data was not available in the LSAC study. While social risks showed promising predictive ability for academic outcomes, it was surprising that risks were not as predictive for health outcomes given the known links between social disadvantage and poor health ( Colvin et al, 2013 ; Procter et al, 2020 ; Russell et al, 2014 ).…”

The hospital burden of intergenerational contact with the welfare system:A whole-of-population liked data study

“…While welfare receipt has been associated with poorer mental health outcomes, 11,24,26,29 our study showed IWC children experience even higher mental health hospitalisation rates compared to WC experienced only in one generation. We expected IWC children to have higher injury hospitalisation rates given injury hospitalisation is more frequent in children from the most disadvantaged backgrounds 40,41 but this had not been quantified before. IWC children having higher hospitalisation rates related to pregnancy and childbirth reflects the inclusion of welfare payments associated with parenting.…”

“…40 Primary diagnosis codes used to identify paediatric Complex Chronic Conditions (CCCs) were adapted to the ICD-10-AM coding system. 41…”