Abstract

BackgroundChildren who leave the emergency department (ED) without complete evaluation or care (LWCET) have poorer outcomes in general. Previous studies have found that American Indian (AI) children have higher rates of LWCET than other racial or ethnic groups. Therefore, this study aims to examine LWCET in AI children by exploring differences by ED location and utilization patterns.MethodsThis is a retrospective cohort study of five EDs in the upper Midwest between June 2011 and May 2012. We included all visits by children aged 0–17 who identified as African American (AA), AI or White. Logistic regression was used to determine differences in LWCET by race and ED location controlling for other possible confounding factors including sex, age, insurance type, triage level, distance from ED, timing of visit, and ED activity level.ResultsLWCET occurred in 1.73% of 68,461 visits made by 47,228 children. The multivariate model revealed that AIs were more likely to LWCET compared to White children (Odds Ratio (OR) = 1.62, 95% Confidence Interval (CI) = 1.30–2.03). There was no significant difference in LWCET between AA and White children. Other factors significantly associated with LWCET included triage level, distance from the ED, timing of visit, and ED activity level.ConclusionOur results show that AI children have higher rates of LWCET compared to White children; this association is different from other racial minority groups. There are likely complex factors affecting LWCET in AI children throughout the upper Midwest, which necessitates further exploration.

Highlights

  • Children who leave the emergency department (ED) without complete evaluation or care (LWCET) have poorer outcomes in general

  • Our results show that American Indian (AI) children have higher rates of LWCET compared to White children; this association is different from other racial minority groups

  • Over half of the ED visits were made by White children (53.50%), while 36.66% and 9.84% were by AA and AI children, respectively

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Summary

Introduction

Children who leave the emergency department (ED) without complete evaluation or care (LWCET) have poorer outcomes in general. Previous studies have found that American Indian (AI) children have higher rates of LWCET than other racial or ethnic groups. Leaving the emergency department (ED) without complete evaluation and treatment is a growing issue that can lead to serious medical conditions, additional cost, recurring ED/primary care visits, hospitalization or other preventable, adverse events [1,2,3,4]. This is especially concerning among American Indian (AI) children, who have higher overall ED visit rates and more visits per child compared to other racial/ethnic groups [7]. Many AI children lack a medical home, and rely heavily on the ED for primary health care [8, 10]

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