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. © Canadian Association of Emergency Physicians.