Children referred to an emergency department by an after-hours call center: complaint-specific analysis

Abstract

Background and objectives: Approximately 20% of phone calls to after-hours call centers result in referrals to the emergency department (ED), but data regarding ED management and disposition are lacking. We sought to determine the acuity of illness of referred children as reflected by triage classifications and need for therapeutic interventions, diagnostic testing, and hospitalization, and to stratify the analysis of ED management and dispositions by chief complaints.

Design and methods: Patients referred to the ED by the after-hours call centers, without physician consultation, were identified. The 4 most common groups of chief complaints resulting in ED referral were determined, and the records of these children were analyzed.

Results: The 525 patients with chief complaints related to the following organ systems were studied: lower respiratory tract, 263 (50%); gastrointestinal, 104 (20%); head, ears, eyes, nose, and throat, 84 (16%); and upper respiratory tract, 74 (14%). The proportion of children referred for lower respiratory tract complaints who received the after-hours call centers call dispositions (99%) or ED triage classifications (38%) of highest priorities, or who required therapeutic interventions (73%), diagnostic testing (40%), or hospitalization (22%) was significantly higher than for all other categories. Thirteen percent with gastrointestinal complaints, referred primarily for dehydration, required intravenous fluids, and 2% of head, ears, eyes, nose, and throat patients required hospitalization.

Conclusions: Children referred to the ED for illnesses related to the lower respiratory tract, principally wheezing, had illnesses of high acuity. On the other hand, current criteria for ED referral for children in the gastrointestinal, head, ears, eyes, nose, and throat, and upper respiratory tract categories result in the referral of many children with nonurgent problems. These data support a reassessment of current referral practices for children with these complaints.