The Clinical Differences between Urgent Visits and Non-Urgent Visits in Emergency Department During the Neonatal Period

Abstract

As neonates are brought to the emergency department (ED) for various complaints, it is challenging for emergency physicians to clinically determine the urgency of the visit. We sought to explore clinical characteristics associated with urgent visits to the ED. We conducted a retrospective study by reviewing medical records of neonatal visits to a tertiary pediatric regional emergency center for 5 years. Cases of patients who were discharged after checking only chest or abdominal X-ray or discharged without workup, were classified as non-urgent visits. Cases where more examinations were performed, or when the patient was hospitalized, were classified as urgent visits. Various clinical features and process in the ED were compared between the groups. Of the 1,008 cases enrolled in this study, 856 (84.9%) were urgent and 152 (15.1%) were non-urgent visits. After adjustment by multiple logistic regression analysis, non-urgent visits were associated with self-referrals rather than physician-referrals (odds ratio [OR], 5.96), visits in the evening rather than at night or daytime (OR, 2.51), patient visits from home rather than from medical facilities (OR, 2.19; 95). Fever and jaundice were the most common complaints (25.7% and 24.5%, respectively), and their OR of non-urgent visit was relatively low (adjusted OR 0.03 and 0.03, respectively). However, other common complaints, such as vomiting and cough (7.4% and 7.1%, respectively), were more likely to be non-urgent visits (adjusted OR 2.96 and 9.83, respectively). For suspected non-urgent visits, emergency physicians need to try to reduce unnecessary workup and shorten length of stay in ED.

Keywords: Emergency Department; Neonate; Non-urgent; Urgent.

Fig 1

Flow chart of patient inclusion. PED = pediatric emergency department, NICU = neonatal intensive care unit, DAMA = discharge against medical advice, DOA = dead on arrival.

Fig 2

Plot of adjusted ORs with 95% CIs for the risk of non-urgent visit according to chief complaint. The subgroup whose chief complaint was irritability, cough, skin redness, and vomiting was significantly associated with non-urgent visits. On the contrary, when the chief complaint was fever or jaundice, the OR was significantly low. Plotted with logarithmic scales. Adjusted for sex, age, mode of birth, prematurity, weight, residence, referral route, visit time. OR = odds ratio, CI = confidence interval.