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Insights from and limitations of data linkage studies: analysis of short-stay urgent admission referral source from routinely collected Scottish data
  1. Smita Dick1,
  2. Richard Kyle2,
  3. Philip Wilson3,
  4. Lorna Aucott4,
  5. Emma France5,
  6. E King5,
  7. Cari Malcolm6,
  8. Pat Hoddinott5,
  9. Stephen W Turner1,7
  1. 1 Child Health, University of Aberdeen, Aberdeen, UK
  2. 2 Academy of Nursing, University of Exeter, Exeter, UK
  3. 3 Institute of Health and Wellbeing, University of Aberdeen, Aberdeen, UK
  4. 4 Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
  5. 5 Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
  6. 6 School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
  7. 7 Women and Children Division, NHS Grampian, Aberdeen, UK
  1. Correspondence to Dr Stephen W Turner, Child Health, University of Aberdeen, Aberdeen, UK; s.w.turner{at}


Introduction This study identified the referral source for urgent short-stay admissions (SSAs) and compared characteristics of children with SSA stratified by different referral sources.

Methods Routinely acquired data from urgent admissions to Scottish hospitals during 2015–2017 were linked to data held by the three referral sources: emergency department (ED), out-of-hours (OOH) service and general practice (GP).

Results There were 171 039 admissions including 92 229 (54%) SSAs. Only 171 (19%) of all of Scotland’s GP practices contributed data. Among the subgroup of 10 588 SSAs where GP data were available (11% all SSA), there was contact with the following referral source on the day of admission: only ED, 1853 (18%); only GP, 3384 (32%); and only OOH, 823 (8%). Additionally, 2165 (20%) had contact with more than one referral source, and 1037 (10%) had contact with referral source(s) on the day before the admission. When all 92 229 SSAs were considered, those with an ED referrer were more likely to be for older children, of white ethnicity, living in more deprived communities and diagnosed with asthma, convulsions or croup. The odds ratio for an SSA for a given condition differed by referral source and ranged from 0.07 to 1.9 (with reference to ED referrals).

Conclusion This study yielded insights and potential limitations regarding data linkage in a healthcare setting. Data coverage, particularly from primary care, needs to improve further. Evidence from data linkage studies can inform future intervention designed to provide safe integrated care pathways.

  • Health services research
  • Emergency Care
  • Child Health Services
  • Paediatric Emergency Medicine
  • Primary Health Care

Data availability statement

Data may be obtained from a third party and are not publicly available.

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Data availability statement

Data may be obtained from a third party and are not publicly available.

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  • Twitter @richardgkyle, @SteveTurnerABDN

  • Contributors SWT, RK, EF, CM, LA, PW and PH conceived the idea. SD, LA and SWT undertook the quantitative work. CM, EK, EF and PH undertook the qualitative work. SWT wrote the first draft of the manuscript and is the guarantor of the work.

  • Funding The study was funded by the Chief Scientist Officer (HIPS/18/09).

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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