The characteristics of the included studies
| Study and country | Design and methods | Setting and participants | Main findings | Quality assessment |
| Berry et al29, USA | Qualitative study—ethnographic Audiotaped ethnographic interviews | ED 31 parents interviewed | Long appointment wait with general practitioner (GP) Dissatisfaction with GP Communication problems with primary healthcare staff Referral by GP Efficiency Availability of resources in ED Convenience Quality of care in ED ED expertise with children | Good |
| Kua et al35, Singapore | A qualitative study that used a grounded theory approach | ED 49 caregivers | Perceived severity of child’s symptoms Availability of after-hours care Advantages of ED (ie, facilities) Mistrust GP Insurance coverage | Good |
| Brousseau et al32, USA | Qualitative In-depth interviews | ED 26 parents of children and 20 primary care physicians | Reassurance Lack of specific tests and treatments in primary healthcare services Access issues | Good |
| Fieldston et al4, USA | Qualitative Focus group | ED Guardian (parents or grandparents) focus group (n: 25) Health professional focus group (n: 42) | Perceived medical need Accessibility Availability | Good |
| Stanley et al34, USA | Qualitative (multisite, prospective observational study used semi-structured interview) Semi-structured, face-to-face interviews | 13 EDs 422 parents of children aged 6 months to 18 years | Reassurance Perceived urgency Referral by GP No GP appointment available | Good |
| Guttman et al30, USA | Qualitative study guided by a grounded theory approach | 2 EDs Convenience sample of 408 (331 paediatric, 77 adult users) | Relief from pain Reassurance Parents do not want to take sole responsibility Recourse, second opinion, and referral Financial issues Worrisome condition After office-hours services Facilities and staff in ED Shorter wait in ED | Good |
| Grigg et al36, USA | A qualitative study Focus group | Seattle Children’s Hospital in Seattle, Washington 20 participants | Concern about symptoms Delay resulted in serious illness Long clinic wait times | Good |
| Chin et al31, USA | Qualitative study Semi-structured interviews | Paediatric ED 12 parents aged 25–47 years | Referrals to the ED Complexities of poverty and competing priorities Mistrust ED staff expertise | Fair |
| Woolfenden et al33, Australia | Qualitative Semi-structured, in-depth interviews | Paediatric ED in Western Sydney 25 parents of children with non-urgent illness | Parental triage Expertise in ED Access issues Parental expectations | Fair |
| Burokiene et al,28 Lithuania | Quantitative Questionnaire | Tertiary-level teaching Children’s Hospital in Vilnius. A total of 381 patients’ parents | Perceived urgent care need Worsened child’s health Worrying symptoms Low parental health literacy | Fair |
| May et al38, USA | Qualitative Semi-structured interviews | 2 sites including 1 community health clinic and 1 paediatric ED 50 participants in total (20 participant from clinic and 30 from ED) | Health literacy Reassurance Perceived urgency ED advantages including quicker than others, better and timely care Convenience | Fair |
| Soliday and Hoeksel40, USA | Mixed methods Questionnaire with open-ended item (Family Health Questionnaire) | Southwest Washington Medical Centre 388 parents of children aged 0–17 years 141 of 388 parents responded to the open-ended item | Physician office was closed No GP/physician appointments available Referral issues Access issues Financial issues | Fair |
| Williams et al23, Australia | Cross-sectional survey Canadian survey tool developed and used by Truman and Reutter | Paediatric ED in Brisbane, Australia 355 parents of children with non-urgent illness | Perceived urgency Advice sought Positive experiences in ED | Fair |
| Hendry et al5, UK | Cross-sectional design Prospective questionnaire-based survey | A&E Department, Royal Hospital for Sick Children, Edinburgh 465 parents or legal guardian | Child’s problem more appropriate for ED GP would have referred child to the ED anyway Child will be seen more quickly in ED | Fair |
| Phelps et al6, USA | Cross-sectional survey Survey (piloted in the ED of one of the hospitals of the study) | Two urban hospital EDs in a large Midwestern city 200 caretakers who brought their children aged under 16 years | The doctor’s office was closed Thought required immediate care Referred to the ED ED is closer | Fair |
| Benahmed et al9, Belgium | Cross-sectional design Self-administered questionnaires which pretested during 1 week in two hospitals | ED of 12 Belgian hospitals All patients (n: 3117) aged under 15 years. The self-administrated questionnaire was completed by the caregivers | Self-referred without any prior contact with caregiver Referred by a medical doctor Sent by school or child day-care centre | Fair |
| Smith and McNamara26, USA | Cross-sectional survey Questionnaire (not specified) | Brockton Hospital 150 parents of children 15 years of age or younger | Child too sick to wait for office visit Unable to reach local provider No transportation Waiting time shorter in ED Insurance coverage for ED but not for office visit | Fair |
| Brown et al37, Canada | Qualitative study Structured interviews | ED 158 parents of patients aged 0–7 years | Perceived an emergency health problem Convenient time or location Referral issues Regular doctor was not available | Fair |
| Salami et al22, USA | Cross-sectional survey Self-administered questionnaires which were pretested | City hospital in South Bronx, New York 53 caregivers, 44 primary care providers, 34 ED staff | Lack of health insurance Outside GP working hours Availability of diagnostic tests in ED Difficulty in primary care pediatrician appointment Need for reassurance Less waiting time in ED Better hospitality in ED | Fair |
| Ogilvie et al24, UK | Cross-sectional design Use of Paediatric Emergency Department Questionnaire The questionnaire was piloted in the ED prior to use | ED in South West England All English-speaking parents/caregivers whose children attended the ED and were triaged as minor injury/illness 373 responses were analysed | Sought advice Perceived to be more serious Perceived appropriateness of destination | Fair |
| Truman and Reutter39, Canada | Mixed methods Employed a 53-item questionnaire containing closed and open-ended questions Cross-sectional design | One hospital in a large Western Canadian city (the city is not specified) 114 parents | Perceived urgency Previous experiences Sought advice Referral | Fair |
| Kubicek et al12, USA | A descriptive study Computer-assisted, self-interviewing) survey administered in either English or Spanish | Children’s Hospital Los Angeles 106 caregivers | I think my child will get care here Doctors here are better Always open I have been here before | Poor |
| Smith et al27, Canada | A cross-sectional survey Survey (Supplemental Digital Content: http://links.lww.com/PEC/A87) | British Columbia Children’s Hospital Paediatric ED 340 families | Negative experiences in GP Geographic proximity Did not know child could be seen elsewhere Wait time felt to be shorter at ED Easy access to ED | Poor |
| Doobinin et al25, USA | Cross-sectional survey Survey. The study tool consisted of a 31-question survey developed by the investigators that underwent significant pretesting and revision | Urban children’s hospital in the USA Guardians of children 251 surveys were completed | Convenience Perceived true emergency Lack of other access to a physician | Poor |