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Emergency medicine

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N. P. France, J. L. Craze.Oxford Radcliffe Hospitals Trust, Oxford, UK

Introduction and Aims: Although there have been a number of studies exploring reasons why children with minor illnesses attend emergency departments, there have been no published studies looking at changes in the incidence and nature of these attendances with time. This is of particular interest following recent changes to primary care out-of-hours provision. We examined trends in the attendance rates, referral patterns, and outcomes for children with medical illnesses attending our emergency department (ED) over a 12 year period.

Methods: We used the computerised booking-in system in the emergency department to collected anonymised data for all children attending with a medical complaint for the month of January 2005. Results were compared with those of previous studies, using the same methodology, for January 1993, 2000, 2003, and 2004. We examined changes in total number of attendances, the source of referral (GP referral v self-presentation) and outcome (admission v discharge).

Results: We identified a year-on-year increase in the total number of children with medical problems attending the emergency department over the period studied. The total attendances in January 2005 were more than double those in January 2000. The increase in attendances was largely due to an increase in self-presenters, the number of which rose steadily from 1993 to 2004 (trebling within that time period) and steeply—by approximately 75%—between 2004 and 2005. The number of GP referrals remained unchanged with no identified trend. The ratio of GP referrals: self-presenters was 3:1 in 1993 but by January 2005 it had reversed to 1:3. There was a downward trend in the proportion of self-referrals being admitted to the wards over the time period 1993 to 2004. In 2005 there was a small increase in admissions for this group. There was no clear trend …

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