The Frequent Use of Emergency Departments Among the Pediatric Population: A Retrospective Analysis in Rome, Italy

TL;DR

This study in Rome found that a small percentage of children frequently use emergency departments, but their use is often appropriate due to their specific health needs.

Contribution

The study identifies patient-specific factors influencing frequent and appropriate ED use among children in Rome.

Findings

3.5% of pediatric patients were frequent users, accounting for over 10% of ED attendances.

Younger age and more severe clinical presentations were linked to appropriate ED use.

Primary care providers and districts had no significant impact on ED attendance frequency.

Abstract

Background/Objectives: Inappropriate use of emergency department (ED) services is widely acknowledged to have a negative impact on health systems as a whole. A minor portion of Frequent User (FU) patients are often responsible for the disproportionate use of ED services. Methods: A retrospective population study was conducted on the attendances of pediatric EDs from 1 January 2022 to 31 December 2022 at the Roma 1 Local Health Authority in Rome, a territory served by more than 13 EDs. Nested logistic regression analysis was used to investigate patient characteristics in predicting inappropriate use of EDs. Results: In 2022, 35,691 pediatric ED attendances were recorded, with 24,824 patients distributed among 904 PCP/GPs in the six districts. A total of 71.8% of patients had only one attendance in 2022. A total of 3.5% of the patients were FUs, who were responsible for more than 10% of the attendances. However, most of the attendances were not appropriate. FUs, younger age (<2 yo), and more severe clinical presentations were more likely to be associated with appropriate ED attendance. PCPs/GPs and districts do not have a role in determining a higher number of ED attendances. The single patient’s characteristics have a greater influence on this phenomenon. Conclusions: Frequent use of the ED is not associated with inappropriate use among children, mainly due to the characteristics and needs of specific patients. However, parents’ education for a more rational use of health system resources and the provision of local solutions to children’s health needs may allow for a more appropriate use of health service resources.

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