The association between deprivation levels, attendance rate and triage category of children attending a children's accident and emergency department

Abstract

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...

A spatially disaggregate analysis of road casualties in England

“…We also find a positive association with increased fatalities but only at the 90% level of significance. This is consistent with the results of Abdalla et al (1997), Chichester et al (1998) and Beattie et al (2001) who also found that there is a positive correlation between area deprivation and traffic casualties. However, our results are less convincing when we look at only motorized casualties.…”

“…They did not control for other effects, such as the level of infrastructure or the land use of the zone. Beattie et al (2001) found that admission to accident and emergency departments is not only related to severity of injury but also to deprivation category. The paper did not just evaluate traffic-related casualties, but all injury accidents.…”

Factors associated with early neonatal attendance to a paediatric emergency department

“…Deprivation was also a significant factor in attendance at PED and has been recognised in previous studies involving children 20 21. Targeted community support has been shown to reduce PED use by children from deprived communities, by developing and strengthening support networks and signposting appropriate services 22…”

Emergency Care Services

“…In a similar vein, a clear positive association has been established in the United States between social deprivation and the use of the ED (Beattie, Gorman and Walker, 2001;Walls, Rhodes and Kennedy, 2002). Using the 1998 National Health Interview Survey, Walls, Rhodes and Kennedy (2002) showed that ethnicity, a low educational level and a lack of health insurance were all associated with a higher likelihood of visiting an ED as a usual source of care.…”