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

Abstract

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. RÉ SUMÉObjectif: L'é tude visait à é valuer la pré valence des é vé nements dé favorables survenus chez les enfants qui quittent le service d'urgence (SU) sans avoir é té vus par un mé decin. Mé thode: Il s'agit d'une é tude de cohortes prospective, d'une duré e de 1 an, mené e dans un SU de soins tertiaires en pé diatrie. Un certain nombre d'enfants choisis au hasard, parmi tous ceux qui avaient moins de 19 ans et qui avaient quitté le SU sans avoir é té vus par un mé decin, ont é té joints par té lé phone, de 4 à 6 jours aprè s la demande de consultation. Le principal critè re d'é valuation consistait en la survenue d'é vé nements dé favorables, dé finis de maniè re prospective, à l'aide de la mé thode Delphi, par 15 pé diatres urgentologues. Les é vé nements dé favorables ont é té dé finis comme l'hospitalisation, la né cessité d'une intervention effractive (administration intraveineuse ou intramusculaire de mé dicaments, ré duction de fractures, pose d'un appareil plâ tré , intervention chirurgicale), une tentative de suicide, ou la mort dans les 72 heures suivant le dé part du SU sans examen pré alable par un mé decin. Quant au critè re d'é valuation secondaire, plusieurs facteurs pré visionnels possibles d'é vé nement dé favorable ont fait l'objet d'é valuation. La premiè re analyse visait à é valuer la proportion d'é vé nements dé favorables chez les enfants qui...

Children Who Leave the Emergency Department Without Being Seen: Why Did They Leave and What Would Make Them Stay?

“…21 In our sample, patients who LWBS sought further medical care significantly more than controls (78.2% vs 11%). 1,13,15,17,21 This value is higher than the one reported in previous studies (13% -67%). However, this variability might be due to different temporal definitions of 'follow-up period' adopted by each study.…”

Étude des facteurs hospitaliers associés aux départs avant prise en charge médicale à l’urgence d’un centre hospitalier de soins tertiaires

“…13,[35][36][37][38] La littérature internationale suggère plutôt des taux entre 0,06% et 20%. 5,7,9,10,16,17,20,24,28,29,32,33,39,40 Aussi, la durée moyenne de séjour dans les urgences au Québec est comparable à celle de notre étude soit de 8h16 min globalement et 16h43 pour les patients sur civières.…”

“…1,[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Certains DAPCM peuvent avoir des codes de triage urgents. 14,20 Les facteurs les plus souvent associés au DAPCM sont : l'achalandage de l'urgence, 5,6,[21][22][23][24] le temps d'attente jugé trop long, 4,5,9,10,17,20,[25][26][27][28][29] l'attribution d'un code de triage moins urgent, 5,6,17,20,27,[30][31][32][33] les caractéristiques intrinsèques du médecin de garde, 21,23 un jeune âge, [5][6]…”

“…14,20 Les facteurs les plus souvent associés au DAPCM sont : l'achalandage de l'urgence, 5,6,[21][22][23][24] le temps d'attente jugé trop long, 4,5,9,10,17,20,[25][26][27][28][29] l'attribution d'un code de triage moins urgent, 5,6,17,20,27,[30][31][32][33] les caractéristiques intrinsèques du médecin de garde, 21,23 un jeune âge, [5][6][7]9,10,29 être un patient ambulatoire, 7,10,20,32 une résolution des symptômes… 14,18,20 Il existe peu d'études qui se penchent sur les DAPCM dans un contexte canadien 13,26,[34][35][36][37]…”

Crianças que Abandonam a Urgência Pediátrica: Oportunidades Perdidas?

“…[5][6][7] Idealmente, esta percentagem devereria ser inferior a 2%. 8 A evolução desfavorável da criança que abandona a UP tem sido alvo de estudos prospectivos 9,10 e é definida como a n o s a necessidade de internamento, procedimentos invasivos (terapêutica endovenosa, intervenção cirúrgica), transferência para uma Unidade de Cuidados Intensivos ou morte, nas 72 horas que se seguem ao abandono. Na literatura, estão descritas taxas de internamento para estes doentes que variam entre 1.5% a 4%.…”