Patients who leave the pediatric emergency department without being seen: a case-control study
Bibliographic record
Abstract
BACKGROUND: Children who visit pediatric emergency departments (EDs) and leave before being seen by a physician may present with particular health problems and may be at risk for preventable health outcomes. We compared children who left without being seen with those who stayed and were seen by a pediatrician, and followed all of the study subjects after they left the ED. METHODS: We asked all parents of children who visited the ED between July 1 and Oct. 31, 2002, to participate. Parents were interviewed by a trained ED research assistant. We abstracted data from the ED medical records. We used the Canadian Emergency Department Triage and Acuity Scale (CTAS) to measure the acuity of the illness or injury. Each child who left without being seen was matched with 2 children who had been seen by selecting the next patients on an alphabetical list by day, sex and age (within 1 year). We did follow-up interviews with parents within 96 hours of the visit to determine the reason for leaving and any treatment and diagnoses received subsequent to the ED visit. RESULTS: Of the 11 087 children seen in the ED during the study period, 289 (3%) left without being seen. Of the 289, the families of 158 (56%) consented to participate in the study and met the study criteria. The case and control groups thus consisted of 158 and 316 children respectively. Of the children who left without being seen, 24 (15%) were triaged as "urgent," and none had a CTAS score of less than 3. A total of 99 children (63%) who left were taken by their families elsewhere for further medical care, compared with 89 (28%) of those who stayed. Waiting too long and resolution of symptoms accounted for 92 (58%) and 59 (37%) of the premature departures respectively. One child who left without being seen was subsequently admitted to hospital. Multivariate analysis showed that, after adjustment for time of arrival and time to reach the ED, children who left without being seen had lower acuity than those who stayed (odds ratio [OR] 4.0, 95% confidence interval [CI] 2.2-7.2) and were more likely to register in the ED between midnight and 4 am (OR 5.9, 95% CI 2.8- 12.5). Children in the premature departure group were also more likely to be taken elsewhere for follow-up care (unadjusted OR 4.3, 95% CI 2.9-6.4). INTERPRETATION: Children who left the ED without being seen had lower acuity levels and were more likely to be taken elsewhere for follow-up care than children who stayed. Most of those who left did so because the wait was too long or their symptoms resolved.
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How this classification was reachedexpand
Direct model labels (unvalidated)
Per-model category and study-design labels from the labeling rounds. They are machine output, unvalidated, and the disagreement between models ships as data. No study design here is MEDLINE-validated yet.
| Model arm | Categories | Study design | Confidence |
|---|---|---|---|
| gemma | no category Domain: not available · Genre: Empirical About the Canadian research system: no · About a Canadian topic: no | Observational | low |
| gpt | no category Domain: not available · Genre: Empirical About the Canadian research system: no · About a Canadian topic: no | Observational | high |
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedLabeled directly by 2 models reading the full record.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".