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Comparing resource use between paediatric emergency department visits by triage level
  1. Margaret E Samuels-Kalow1,2,
  2. Matthew Niedzwiecki3,4,
  3. Ari B Friedman5,
  4. Peter E Sokolove3,
  5. Renee Y Hsia3,4
  1. 1 Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  2. 2 Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  3. 3 Department of Emergency Medicine, University of California, San Francisco, California, USA
  4. 4 R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
  5. 5 Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  1. Correspondence to Dr Margaret E Samuels-Kalow, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; msamuels-kalow{at}


Objective The majority of paediatric ED visits result in discharge but little is known about what ED resources are deployed for these visits. The goal of this study was to understand the utilisation of diagnostic testing, procedures and hospital admission for paediatric ED visits triaged as ‘non-urgent’.

Study design We examined US ED visits for children aged 0–17 years from 1 January 2009 to 31 December 2011 in the National Hospital Ambulatory Medical Care Survey. Visits triaged on arrival as ‘non-urgent’ (level 5) were compared with urgent visits (triage levels 1–4) for resource use and disposition. Sensitivity and specificity of triage for predicting resource use and disposition were assessed.

Results Among 21 052 observations, representing 86 620 988 visits, 11.1% were triaged as ‘non-urgent’. Diagnostic services were provided during 37.6% (95% CI 33.9% to 41.4%) of non-urgent and 55.2% (95% CI 53.3% to 57.2%) of urgent visits. Procedures were performed in 23.9% (95% CI 20.4% to 27.3%) of non-urgent and 33.9% (95% CI 31.2% to 35.9%) of urgent visits. 1.7% (95% CI 0.09% to 2.6%) of the non-urgent visits resulted in admission, with 0.08% (95% CI 0% to 0.2%) to critical care units, compared with 4.4% (95% CI 3.6% to 5.2%) of the urgent visits, with 0.3% (95% CI 0.2% to 0.4%) to critical care. Despite some substantial differences in the rates of resource use, triage score had poor sensitivity for identifying patients who did not receive ED tests, procedures or admission.

Conclusion A significant percentage of ED patients with non-urgent ED triage scores received ED testing and procedures. More work is needed to improve methods of prospectively identifying patients with low acuity complaints who do not need significant ED resources.

  • paediatric emergency med
  • emergency department utilisation

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  • Contributors MES-K conceptualised the study and drafted the initial manuscript. MN carried out the analyses, revised and reviewed the manuscript. ABF carried out analyses and critically reviewed with manuscript. PES critically reviewed the manuscript. RYH conceptualised and designed the study, supervised the analysis and critically reviewed the manuscript. All authors approved the manuscript as submitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval This study was deemed exempt from human subjects review at the University of California San Francisco.

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

  • Data sharing statement We used the National Hospital Ambulatory Medical Care Survey (NHAMCS) which is publicly available.

  • Presented at This work was presented in part at SAEM 2017.