# Code Not-So-Blue: Burden and Predictors of Non-urgent Visits to the Surgical Emergency Room in Peshawar, Pakistan

## TL;DR

This study examines non-urgent visits to a surgical emergency room in Pakistan, finding they are common among younger, rural, and low-income individuals.

## Contribution

The study identifies specific socioeconomic and demographic predictors of non-urgent emergency room visits in a low-resource setting.

## Key findings

- Non-urgent visits accounted for 35% of all surgical emergency room visits.
- Female sex, rural residence, low income, and limited education were significant predictors of non-urgent visits.
- Chronic kidney disease was independently associated with non-urgent presentations.

## Abstract

Background: Non-urgent visits to surgical emergency rooms (SERs) are an unnecessary burden on emergency health services, especially in low-resource settings. The aim of this study was to quantify the burden and determine predictors of non-urgent surgical ER visits in a tertiary care setting.

Methods: This is a prospective analysis of the non-urgent visits in our SER over a 15-day period. We included patients of all ages and genders who presented to the SER at the time of data collection. Patients were excluded if they were detained, dead on arrival, or refused to consent. Patients were stratified into two groups based on the surgical urgency: group U (urgent) and group NU (non-urgent), and compared for the baseline characteristics, comorbid conditions, and referral route. Multivariable analyses were used to identify the independent predictors of these non-urgent presentations while controlling for potential confounders.

Results: Non-urgent visits accounted for 147 (35%) of all visits and were associated with younger age, female sex, rural residence, low income, and limited education (p<0.001). Most non-urgent cases were triage-referred (110 (74.8%), p=0.012). Diabetes mellitus (DM) and obesity were more common in urgent cases (p<0.05). Independent predictors of non-urgent visits included female sex (adjusted odds ratio (aOR): 1.50, 95% CI (1.10 - 2.05), p = 0.020), rural residence (aOR: 1.30, 95% CI (1.02 - 1.65), p < 0.040), low income (aOR: 1.40, 95% CI (1.05 - 1.88), p = 0.030), and chronic kidney disease (CKD) (aOR: 1.80, 95% CI (1.10 - 3.20), p = 0.040).

Conclusion: Our study identified the common predictors of non-urgent SER visits in our settings, such as younger age, rural residence, poor socioeconomic status, and lower education level. Combined efforts should focus on improving the triage protocols, access to primary care, patient education, and public health initiatives. Further research should also assess the effectiveness of urgent care clinics and telemedicine in reducing non-urgent ER presentations.