Minor illness and injury: factors influencing attendance at a paediatric accident and emergency department

Abstract

Aims: To gather information on children with minor illness or injury presenting to a paediatric accident and emergency (A&E) department and the decision making process leading to their attendance. Methods: Prospective questionnaire based survey of 465 children selected by systematic sampling from A&E attenders allocated to the lowest triage category. Results: The study population was statistically representative of the total population of A&E attenders. The lower deprivation categories were over represented. Educational attainment, childcare experience, and parental coping skills were important in relation to A&E attendance. More children attended with injury as opposed to illness. There were no significant demographic differences between those children who presented directly to A&E and those who made prior contact with a GP. Just under half the study population had made contact with a general practitioner (GP) before attending A&E. The majority of those children were directly referred to A&E at that point. GPs referred equivalent numbers of children with illness and injury. Conclusions: Parents and GPs view paediatric A&E departments as an appropriate place to seek treatment for children with minor illness or injury.

Socioeconomic deprivation and accident and emergency attendances: cross-sectional analysis of general practices in England

“…In this study, the population proportion of young children (<5 years), was associated with A&E rates, as found in some other studies, 9,28 but the population proportion of older adults (>65, >75, or >85 years) had no significant association. This contrasts with the findings of some studies, 24 but supports others.…”

“…This contrasts with the findings of some studies, 24 but supports others. 9,28 The present study found that the two included ethnic groups were associated with opposite effects on A&E attendance: higher proportions of Asian or Asian British patients were associated with lower A&E attendance rates whereas higher proportions of black or black British patients were associated with higher rates. Earlier studies had shown that white groups used A&E more than those from non-white backgrounds, [11][12][13] although the studies were based on relatively small geographical areas with high proportions of particular non-white ethnic groups and therefore with limited generalisability to other areas of the UK.…”

“…19 It was not possible to include the effect of distance to A&E in this study, which has been found to be important in some previous research, 4,6,12,15 but not others. 28,34 A possible residual confounding factor is the familiarity of the practice population with the organisation of the NHS, likely to be a factor of how long the patients have lived in the UK and which may explain some of the association between A&E attendance and ethnicity. Finally, as with all cross-sectional observational studies, the associations observed can be used to generate hypotheses but cannot demonstrate causality nor explain any observed associations.…”

“…Studies confined to 'self-referrals' may include many patients attending A&E on the advice of healthcare professionals, including those attending for primary care reasons. 28,37 Although discharged attendances are more likely to refer to patients who could have been managed in primary care, this study sought to determine the extent to which primary care could influence total A&E demand, relative to population variables.…”

The frequency distribution of presenting symptoms in children aged six months to six years to primary care

“…We know that parents' choice of utilisation is determined by the availability of care, socio-economic factors (Shipman et al, 1997) and their own health beliefs (Hendry et al, 2005). Qualitative research is needed to improve our understanding of parental decision making when choosing which primary care service provider to attend for their children's presenting symptom.…”