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

Published online by Cambridge University Press:  04 March 2015

Jocelyn Gravel ,
Serge Gouin ,
Benoit Carrière ,
Nathalie Gaucher  and
Benoit Bailey
Jocelyn Gravel*
Affiliation:
Division of Emergency Medicine, Department of Pediatrics, Hôpital Sainte-Justine, Université de Montréal, Montréal, QC
Serge Gouin
Affiliation:
Division of Emergency Medicine, Department of Pediatrics, Hôpital Sainte-Justine, Université de Montréal, Montréal, QC
Benoit Carrière
Affiliation:
Division of Emergency Medicine, Department of Pediatrics, Hôpital Sainte-Justine, Université de Montréal, Montréal, QC
Nathalie Gaucher
Affiliation:
Division of Emergency Medicine, Department of Pediatrics, Hôpital Sainte-Justine, Université de Montréal, Montréal, QC
Benoit Bailey
Affiliation:
Division of Emergency Medicine, Department of Pediatrics, Hôpital Sainte-Justine, Université de Montréal, Montréal, QC
*
Division of Emergency Medicine, Department of Pediatrics, Hôpital Sainte-Justine, Université de Montréal, 3175 Chemin Côte Sainte-Catherine, Montréal, QC H3T 1C5; [email protected].

Abstract

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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.

Keywords

childrenemergency departmentleft without being seentriage
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 15 , Issue 5 , September 2013 , pp. 289 - 299
Copyright
Copyright © Canadian Association of Emergency Physicians 2013

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