Paediatric Visits to Community Emergency Departments: Outcomes from Referrals and Unscheduled Return Visits to a Paediatric Centre
Bibliographic record
Abstract
Abstract BACKGROUND: Approximately 85% of children in Canada who seek emergency care do so in a general emergency department (ED), yet also have access to a dedicated pediatric ED (PED) within reasonable range. Existing pediatric literature describing return visits to the ED for the same medical complaint – an important quality indicator of ED performance – has yet to report on patient flow patterns from general EDs to a PED. OBJECTIVES: We sought to measure the proportion of children seen at general EDs who subsequently present to a PED for further care. We also sought to elucidate the reasons behind this pattern of revisits, and to describe the clinical management provided at the subsequent visit. DESIGN/METHODS: A retrospective cohort study was conducted combining linked administrative databases and health records review. We reviewed all pediatric visits (<17 years of age) at 5 general EDs in Vancouver, linking visits between general EDs and the PED based on clincally compatible presentations. Our primary outcome measure was the proportion of general ED visits with a subsequent visit to a PED (within 7 days) during the 2012-13 fiscal year. Secondary outcomes included reasons for PED consultation, the clinical services accessed, and disposition at the PED. RESULTS: During the study period, 582/17,824 (3.3%) children seen at GEDs subsequently presented to the PED within 7 days. The top 3 diagnoses among these were: fracture, viral infection, and musculoskeletal complaints. Of the 582 children with a visit to the PED, 167 (28.7%) were referred to the PED for a consultation, while the rest were family-initiated. Referred visits were more frequently associated with pediatric subspecialist consultation than family-initiated visits (41.3% versus 21.7%, p<0.01). The referred group more frequently resulted in a surgical procedure (12.0% versus 3.6%, p<0.01) or hospital admission (48.5% versus 11.6%, p<0.01). CONCLUSION: Knowing the proportion, management, and outcomes of children that are treated in a general ED and subsequently at a PED may provide an important quality measure and opportunities to improve the management of common pediatric emergencies in the community.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 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, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
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".