Emergency department frequent users in the paediatric population: a retrospective analysis in Rome

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Abstract Background Recent studies have reported the increasing utilisation of the Emergency Departments (EDs) for non-urgent attendances by people aged <18 years. The aim of this study is to describe the characteristic of the paediatric frequent user (FU) population, highlighting the differences between FUs and non-FUs, and to identify factors linked to appropriate ED attendance, comparing the level of variability attributed to the geographical and family physician components. Methods A retrospective cohort study was carried out of the ED attendances in 2022 in the 8 EDs of the Local Health Authority Roma 1 geographical area, in Rome. The cohort was enrolled from the regional Healthcare Emergency Information System. Records included information on number of attendance, age and gender, usage of emergency medical service (EMS), triage code, appropriateness of attendance. Multivariable nested logistic regression was performed to identify the characteristics of FU and non-FU attendances and the predictors for appropriateness of attendances. Results In 2022, the total number of children with at least 1 ED attendance is 24.824 and a total of 35.691 attendances were recorded. The regression analysis highlights that the appropriateness of attendances is associated to the female gender (OR male: 0.84), age <1 year (OR: 2.06), the usage of EMS (OR: 2.00), high triage code and being a FU (OR FU: 1.53). The family physician group have a greater influence of District group but lower influence of single patient characteristics group to determine the appropriateness of paediatric ED attendances (MOR District: 1.73; MOR PCP: 1.84; MOR single patient characteristics: 2.75). Conclusions Frequent use of the ED is partially associated with an inappropriate use of EDs, mostly due to the specific patients’ characteristics. It is therefore necessary to adopt strategies to improve the appropriate use of health service resources in order to provide quality health solutions to real health needs. Key messages • This is the first study that defines an ED paediatric FU profile in Italy. • It compares the level of variability attributed to the geographical component and family physician components.