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The recent paper by Gill et al reports that emergency admissions of children in England have increased year on year since 2003.1 We have replicated and extended Gill's analysis for Scotland. General hospital discharge (SMR01) records and Accident & Emergency (A&E) attendance records held by the National Health Service (NHS) National Services Scotland Information Services Division were interrogated to identify emergency continuous inpatient stays and new A&E attendances for children aged 0–14 years from 1999–2011 and from 2009–2012, respectively. Continuous inpatient stays are complete stays in hospital from admission to discharge regardless of within and between hospital transfers. National Records for Scotland midyear population estimates provided denominators.
In Scotland, the overall emergency admission rate for children aged 0–14 years was relatively constant between 1999 and 2002, increased gradually to 2006, plateaued to 2009, then declined in 2010 before increasing again in 2011 (figures 1 and 2). There were 54 354 admissions (rate 58.2/1000) in 1999 compared with 55 895 (65.5/1000) in 2011. The comparable rates for England were 63/1000 in 1999 and 81/1000 in 2010. The overall emergency admission rate for children was lower for Scotland than England for every year studied. In terms of secular trends, both countries showed similar patterns from 1999 to around 2006 followed by divergence with rates continuing to rise in England, but showing a much less consistent pattern in Scotland.
Subtrends apparent in the Scottish data are similar to those reported for England. In Scotland, admission rates are highest for infants and the youngest age groups have seen the greatest absolute increase in admission rates (figure 1). Increase in admission numbers and rates is entirely accounted for by very short stay (<1 day, ie, no overnight stay) admissions (figure 2). Just under 30% of admissions have a main diagnosis of a ‘primary care sensitive’ condition as defined by Gill and this proportion has remained fairly constant over the study period. There is considerable variation in admission rates and in the trends in rates between NHS Board areas across Scotland. Rates have, for example, remained fairly unchanged in Greater Glasgow, whereas they have steadily increased over the study period in Ayrshire & Arran and Highland.
Patient level data on A&E attendances in Scotland are available from mid 2009 onwards and the data suggest that attendance rates are increasing over time. There were 251 749 new A&E attendances for children aged 0–14 years in 2010 (rate 295.6/1000) compared with 267 073 (312.8/1000) in 2011 and 279 358 (327.2/1000) in 2012. Around 12% of A&E attendances in children are coded as resulting in hospital admission and this proportion has remained relatively constant over the (short) period with available data. When considered alongside the SMR01 data, these data suggest that around half of all emergency admissions in children come through A&E departments.
Many of the factors that Gill suggests may underlie the persistently increasing admission rates seen in England also pertain to Scotland. The new General Practitioner contract was implemented in April 2004,2 NHS24 (similar to NHS Direct) between 2002 and 2004,3 and a 4 h A&E waiting times target in 2004.4 ‘Walk-in’ primary care centres and NHS 111 do not operate in Scotland.
The available data suggest that emergency care for children is under pressure across the UK, although the situation appears somewhat more favourable in Scotland. In Scotland, A&E attendance rates for children are increasing. Emergency admission rates increased to 2006, but unlike in England, this increase subsequently stalled and even reversed. Rates did increase again between 2010 and 2011, however, and future trends remain uncertain.
Data comparability issues may underlie some of the differences observed between Scotland and England, but on balance it is likely that regional and local factors, as well as the UK-wide context, contribute substantially to trends in use of unscheduled paediatric care.
We acknowledge the support of various colleagues within the NHS National Services Scotland Information Services Division in preparing data extract and supplying metadata, in particular, Maighread Simpson and Fiona MacKenzie.
Contributor MB had the original idea for the analysis. RW was responsible for all data analysis and wrote the first draft of the manuscript. PW provided advice on relevant aspects of Scottish health service organisation and delivery. All authors reviewed and contributed to the final draft of the manuscript.
Ethics approval All analyses were undertaken within the NHS National Services Scotland Information Services Division (ISD) with only aggregated, non-patient–identifiable results released out with ISD. No approval was therefore required from the Privacy Advisory Committee.
Competing interests None.
Provenance and peer review Not commissioned; internally peer reviewed.
Data sharing statement Researchers wishing to access Scottish routine health data for research purposes should contact NHS National Services Scotland Information Services Division (NSS.eDRIS@nhs.net).
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