Article Text

  1. A Willems,1,2,
  2. F Otte1,2,
  3. C Fonteyne1,2,
  4. A Jacobs1,
  5. T Khalil1,2,
  6. D Biarent1,2
  1. 1Emergency Department, Hôpital Universitaire Des Enfants Reine Fabiola, Brussels, Belgium
  2. 2Pediatric Intensive Care Unit, Hôpital Universitaire Des Enfants Reine Fabiola, Brussels, Belgium


Objective Overpopulation is a major problem encountered in paediatric emergency departments. Triage of emergencies has been proposed as a possible solution. We compared the degree of emergency assignments between parents, specialist registrars (SR) and paediatric emergency physicians (PEP) in order to understand parental perception of their child’s illness.

Methods The questionnaire survey was conducted in all consecutive patients of the PED of a tertiary hospital during two periods. The accompanying parent and the SR rated the child using the following scale: 1, real emergency; 2, not urgent but treatment is needed rapidly; 3, visit without any emergency character. The medical records were reviewed independently by two PEP. Kappa statistics were calculated.

Results Summer 2002: the response rate was 77.3% (n  =  978/1265). Mean child age was 65.3 ± 55.5 months. Parents rated emergency department visits as follows: 1, 35.6%; 2, 47.6% and 3, 16.8%. The kappa level of agreement was 0.129 between parents and SR, 0.07 between parents and PEP and 0.91 between specialist SR and PEP. Winter 2003: the response rate was 82.1% (n  =  663/808). Mean child age was 55.4 ± 53.9 months. Parents rated the emergency department visit as follows: 1, 43.8%; 2, 38.8% and 3, 17.5%. The kappa level of agreement was 0.09 between parents and SR, 0.04 between parents and PEP and 0.55 between SR and PEP.

Conclusions The level of agreement was poor between parents and physicians and substantial between SR and PEP. Parents perceived their child’s condition as more emergent than the actual emergency level assigned by physicians. Parents’ misperception of an emergency is one of the factors associated with inappropriate paediatric emergency department use.

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