Background Frequent attendances of the same users in emergency departments (ED) can intensify workload pressures and are common among children, yet little is known about the characteristics of paediatric frequent users in EDs.
Aim To describe the volume of frequent paediatric attendance in England and the demographics of frequent paediatric ED users in English hospitals.
Method We analysed the Hospital Episode Statistics dataset for April 2014–March 2017. The study included 2 308 816 children under 16 years old who attended an ED at least once. Children who attended four times or more in 2015/2016 were classified as frequent users. The preceding and subsequent years were used to capture attendances bordering with the current year. We used a mixed effects logistic regression with a random intercept to predict the odds of being a frequent user in children from different sociodemographic groups.
Results One in 11 children (9.1%) who attended an ED attended four times or more in a year. Infants had a greater likelihood of being a frequent attender (OR 3.24, 95% CI 3.19 to 3.30 vs 5 to 9 years old). Children from more deprived areas had a greater likelihood of being a frequent attender (OR 1.57, 95% CI 1.54 to 1.59 vs least deprived). Boys had a slightly greater likelihood than girls (OR 1.05, 95% CI 1.04 to 1.06). Children of Asian and mixed ethnic groups were more likely to be frequent users than those from white ethnic groups, while children from black and 'other' had a lower likelihood (OR 1.03, 95% CI 1.01 to 1.05; OR 1.04, 95% CI 1.01 to 1.06; OR 0.88, 95% CI 0.86 to 0.90; OR 0.90, 95% CI 0.87 to 0.92, respectively).
Conclusion One in 11 children was a frequent attender. Interventions for reducing paediatric frequent attendance need to target infants and families living in deprived areas.
- urgent care
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Handling editor Simon Carley
Contributors GG was involved with conception and design, conducted the data analysis and drafted the manuscript. MB was involved with acquisition of funding, conception and design, data analysis and revised various versions of the manuscript. PPA was involved with acquisition of funding conception and design, data collection and analysis, and revised various versions of the manuscript. SS was involved with acquisition of funding, conception and design, data analysis, and revised various versions of the manuscript. AM was involved with acquisition of funding, conception and design, data analysis, and revised various versions of the manuscript. AB was involved with acquisition of funding, conception and design, data collection and analysis, and revised various versions of the manuscript. All authors read and approved the final manuscript.
Funding This report is independent research supported by the National Institute for Health Research Applied Research Collaboration Northwest London. The views expressed in this publication are those of the authors and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care. The Dr Foster Unit is an academic unit in the Department of Primary Care and Public Health, within the School of Public Health, Imperial College London. The unit receives research funding from the National Institute of Health Research and Dr Foster Intelligence, an independent health service research organisation (a wholly owned subsidiary of Telstra). The Dr Foster Unit at Imperial is affiliated with the National Institute of Health Research (NIHR) Imperial Patient Safety Translational Research Centre. The NIHR Imperial Patient Safety Translational Centre is a partnership between the Imperial College Healthcare NHS Trust and Imperial College London. The Department of Primary Care & Public Health at Imperial College London is grateful for support from the Imperial NIHR Biomedical Research Centre. SS is funded by the National Institute for Health Research School for Public Health Research (NIHR SPHR) and the NIHR Applied Research Collaboration (ARC). The NIHR School for Public Health Research is a partnership between the Universities of Sheffield; Bristol; Cambridge; Imperial; and University College London; The London School for Hygiene and Tropical Medicine (LSHTM); LiLaC—a collaboration between the Universities of Liverpool and Lancaster; and Fuse—The Centre for Translational Research in Public Health a collaboration between Newcastle, Durham, Northumbria, Sunderland and Teesside Universities.
Disclaimer The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Ethics approval We have approval from the Secretary of State and the Health Research Authority under Regulation 5 of the Health Service (Control of Patient Information) Regulations 2002 to hold confidential data and analyse them for research purposes (CAG ref 15/CAG/0005). The London - South East Ethics Committee (REC ref 15/LO/0824) has approved the use of this data for quality measurement of healthcare delivery.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No data are available. We are unable to share any patient data.
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