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Preschool children who are frequent attenders in emergency departments: an observational study of associated demographics and clinical characteristics
  1. Mitch Blair1,
  2. Alan J Poots2,
  3. Valencia Lim2,
  4. Stephen Hiles3,
  5. Geva Greenfield2,
  6. Caroline Crehan4,
  7. Beverley Kugler4,
  8. Charlotte Boreham4
  1. 1 Department of Paediatrics, Imperial College London, London, UK
  2. 2 NIHR CLAHRC Northwest London, Imperial College London, London, UK
  3. 3 Department of R and D, Northwick Park Hospital, Harrow, UK
  4. 4 Department of Paediatrics, Northwick Park Hospital, Harrow, UK
  1. Correspondence to Professor Mitch Blair, Department of Paediatrics, River Island Academic Centre for Paediatrics and Child Health, Imperial College (Northwick Park Hospital campus), Harrow, Middlesex HA1 3UJ, UK; m.blair{at}


Background Unscheduled visits to emergency departments (ED) have increased in the UK in recent years. Children who are repeat attenders are relatively understudied.

Aims To describe the sociodemographic and clinical characteristics of preschoolers who attend ED a large District General Hospital.

Method/study design Observational study analysing routinely collected ED operational data. Children attending four or more visits per year were considered as ‘frequent attenders’. Poisson regression was used with demographic details (age, sex, ethnicity, sociodemographic status) to predict number of attendances seen in the year. We further analysed detailed diagnostic characteristics of a random sample of 10% of attendees.

Main findings 10 169 patients visited in the 12-month period with 16 603 attendances. 655 individuals attended on 3335 occasions. 6.4% of this population accounted for 20.1% of total visits. In the 10% sample, there were 304 attendances, and 69 (23%) had an underlying chronic long-standing illness (CLSI). This group were 2.4 times more likely to be admitted as inpatients compared with those without such conditions, median length of stay of 6.2 hours versus 2.5 hours (p=NS).

Conclusions Frequent ED attenders fall broadly into two distinct clinical groups: those who habitually return with self-limiting conditions and those with or without exacerbation of underlying CLSI. Both groups may be amenable to both additional nursing and other forms of community support to enhance self-care and continuity of care. Further research is required to increase our understanding of specific individual family and health system factors that predict repeat attendance in this age group.

  • Accident & Emergency
  • General Paediatrics
  • Health services research
  • Data Collection
  • Epidemiology

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  • Contributors MB and AJP conceived the study. MB wrote the final draft. SH extracted data and provided interpretation. AJP and GG carried out statistical analysis. VL wrote the socio-demographic section as part of her Masters thesis. CC, BK and CB contributed to drafts and conducted analysis of clinical records.

  • Funding This study presents independent research commissioned and funded by the National Institute for Health Research (NIHR) under the Collaborations for Leadership in Applied Health Research and Care (CLAHRC) programme for North West London (application reference CLAHRC-2013-10012). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Ethics approval London North West Healthcare Trust R and D committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Unpublished data has not been made available to others outside the research team.