Quynh Doan1, Hubert Wong2, Garth Meckler2, David Johnson2, Antonia Stang2, Andrew Dixon2, Scott Sawyer2, Tania Principi2, April J Kam2, Gary Joubert2, Jocelyn Gravel2, Mona Jabbour2, Astrid Guttmann2. 1. Division of Pediatric Emergency Medicine, Department of Pediatrics (Doan, Meckler), University of British Columbia; School of Population and Public Health (Wong), University of British Columbia; BC Children's Hospital Research Institute (Doan, Meckler), Vancouver, BC; Alberta Children's Hospital Research Institute (Johnson, Stang), University of Calgary, Calgary, Alta; Stollery Children's Hospital, and Women and Children's Health Research Institute (Dixon), University of Alberta, Edmonton, Alta.; Pediatric Emergency Medicine (Sawyer), University of Manitoba; Children's Hospital, Health Sciences Centre Winnipeg (Sawyer), Winnipeg, Man.; Paediatric Emergency Medicine (Principi), University of Toronto; The Hospital for Sick Children (Principi), Toronto, Ont.; Department of Pediatrics (Kam), McMaster University; McMaster Children's Hospital (Kam), Hamilton, Ont.; Paediatric Emergency Medicine (Joubert), Western University; Children's Hospital of Western Ontario (Joubert), London, Ont.; Département de pédiatrie (Gravel), Université de Montréal; CHU Sainte-Justine (Gravel), Montréal, Que.; Department of Pediatrics (Jabbour), University of Ottawa; Children's Hospital of Eastern Ontario (Jabbour), Ottawa, Ont.; ICES (Guttmann); Department of Paediatrics (Guttmann), University of Toronto, Toronto, Ont. qdoan@bcchr.ca. 2. Division of Pediatric Emergency Medicine, Department of Pediatrics (Doan, Meckler), University of British Columbia; School of Population and Public Health (Wong), University of British Columbia; BC Children's Hospital Research Institute (Doan, Meckler), Vancouver, BC; Alberta Children's Hospital Research Institute (Johnson, Stang), University of Calgary, Calgary, Alta; Stollery Children's Hospital, and Women and Children's Health Research Institute (Dixon), University of Alberta, Edmonton, Alta.; Pediatric Emergency Medicine (Sawyer), University of Manitoba; Children's Hospital, Health Sciences Centre Winnipeg (Sawyer), Winnipeg, Man.; Paediatric Emergency Medicine (Principi), University of Toronto; The Hospital for Sick Children (Principi), Toronto, Ont.; Department of Pediatrics (Kam), McMaster University; McMaster Children's Hospital (Kam), Hamilton, Ont.; Paediatric Emergency Medicine (Joubert), Western University; Children's Hospital of Western Ontario (Joubert), London, Ont.; Département de pédiatrie (Gravel), Université de Montréal; CHU Sainte-Justine (Gravel), Montréal, Que.; Department of Pediatrics (Jabbour), University of Ottawa; Children's Hospital of Eastern Ontario (Jabbour), Ottawa, Ont.; ICES (Guttmann); Department of Paediatrics (Guttmann), University of Toronto, Toronto, Ont.
Abstract
BACKGROUND: Emergency department overcrowding has been associated with increased odds of hospital admission and mortality after discharge from the emergency department in predominantly adult cohorts. The objective of this study was to evaluate the association between crowding and the odds of several adverse outcomes among children seen at a pediatric emergency department. METHODS: We conducted a retrospective cohort study involving all children visiting 8 Canadian pediatric emergency departments across 4 provinces between 2010 and 2014. We analyzed the association between mean departmental length of stay for each index visit and hospital admission within 7 days or death within 14 days of emergency department discharge, as well as hospital admission at index visit and return visits within 7 days, using mixed-effects logistic regression modelling. RESULTS: A total of 1 931 465 index visits occurred across study sites over the 5-year period, with little variation in index visit hospital admission or median length of stay. Hospital admission within 7 days of discharge and 14-day mortality were low across provinces (0.8%-1.5% and < 10 per 100 000 visits, respectively), and their association with mean departmental length of stay varied by triage categories and across sites but was not significant. There were increased odds of hospital admission at the index visit with increasing departmental crowding among visits triaged to Canadian Triage and Acuity Scale (CTAS) score 1-2 (odds ratios [ORs] ranged from 1.01 to 1.08) and return visits among patients with a CTAS score of 4-5 discharged at the index visit at some sites (ORs ranged from 1.00 to 1.06). INTERPRETATION: Emergency department crowding was not significantly associated with hospital admission within 7 days of the emergency department visit or mortality in children. However, it was associated with increased hospital admission at the index visit for the sickest children, and with return visits to the emergency department for those less sick.
BACKGROUND: Emergency department overcrowding has been associated with increased odds of hospital admission and mortality after discharge from the emergency department in predominantly adult cohorts. The objective of this study was to evaluate the association between crowding and the odds of several adverse outcomes among children seen at a pediatric emergency department. METHODS: We conducted a retrospective cohort study involving all children visiting 8 Canadian pediatric emergency departments across 4 provinces between 2010 and 2014. We analyzed the association between mean departmental length of stay for each index visit and hospital admission within 7 days or death within 14 days of emergency department discharge, as well as hospital admission at index visit and return visits within 7 days, using mixed-effects logistic regression modelling. RESULTS: A total of 1 931 465 index visits occurred across study sites over the 5-year period, with little variation in index visit hospital admission or median length of stay. Hospital admission within 7 days of discharge and 14-day mortality were low across provinces (0.8%-1.5% and < 10 per 100 000 visits, respectively), and their association with mean departmental length of stay varied by triage categories and across sites but was not significant. There were increased odds of hospital admission at the index visit with increasing departmental crowding among visits triaged to Canadian Triage and Acuity Scale (CTAS) score 1-2 (odds ratios [ORs] ranged from 1.01 to 1.08) and return visits among patients with a CTAS score of 4-5 discharged at the index visit at some sites (ORs ranged from 1.00 to 1.06). INTERPRETATION: Emergency department crowding was not significantly associated with hospital admission within 7 days of the emergency department visit or mortality in children. However, it was associated with increased hospital admission at the index visit for the sickest children, and with return visits to the emergency department for those less sick.
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