Emergency Department Presentations by Children in Remote Australia: A Population-based Study

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Abstract

Background. Aboriginal leaders invited us to examine the frequency and reasons for emergency department (ED) presentations by children in remote Western Australia, where Prenatal Alcohol Exposure (PAE) is common. Methods. ED presentations (2007-11 inclusive) were examined for all children born in the Fitzroy Valley in 2002-03. Results. ED data for 127/134 (94.7%) children (95% Aboriginal) showed 1058 presentations over 5-years. Most (81%) had at least 1 presentation (median 9.0, range 1-50). Common presentations included: screening/follow-up/social reasons (16.0%), injury (15.1%), diseases of the ear (14.9%), skin (13.8%), respiratory tract (13.4%), and infectious and parasitic diseases (9.8%). PAE and higher presentations rates were associated. Commonly associated socio-economic factors were household over-crowding, financial and food insecurity. Conclusion. Children in very remote Fitzroy Crossing communities have high rates of preventable ED presentations, especially those with PAE. Support for culturally appropriate preventative programs and improved access to primary health services need to be provided in remote Australia.

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Most cited references 25

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The relationship between parent health literacy and pediatric emergency department utilization: a systematic review.

Andrea K Morrison, Matthew Myrvik, David C Brousseau … (2016)

Low health literacy in parents can potentially impact understanding of a child's diagnosis and treatment course. No reviews have addressed parent health literacy in the emergency department (ED), the relationship between parent health literacy and child ED utilization, or the impact of low literacy interventions on child ED utilization. To systematically evaluate the peer-reviewed literature pertaining to parental health literacy and ED utilization. The following key questions were addressed: question (Q) 1) What is the prevalence of low health literacy, as estimated by validated health literacy measures, of parents in the ED? Q2) Is parent low health literacy related to ED use for children? Q3) Do low literacy interventions targeting parents likely to have low health literacy affect ED use for children? The authors reviewed 483 unduplicated titles and abstracts published between 1980 and May 2012 using PubMed and CINAHL, with 117 retained for full review and 17 included in the final analytic review. All included articles had a valid measure of parent health literacy and a Q1) descriptive measurement of the population, Q2) ED utilization, or Q3) utilized a low literacy educational intervention. One author extracted data verified by a second author. Studies were rated for quality by both authors. Q1) A median of 30% (interquartile range 22-36%) of parents in the ED possesses low health literacy. Q2) Studies investigating the relationship between health literacy and ED yielded mixed results. Q3) Seven of 8 low literacy interventions were associated with a reduction in ED use. Random effects pooled odds ratios from 6 studies showed intervention effectiveness (odds ratio 0.35; 95% CI 0.15-0.81). No intervention studies measured health literacy, limiting the ability to determine whether the low literacy intervention targeted health literacy. Roughly 1 in 3 parents of children presenting to the ED have low health literacy. Importantly, interventions targeting parents likely to have low health literacy have an impact in reducing ED utilization. Copyright © 2013 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

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Global burden, distribution, and interventions for infectious diseases of poverty

Zulfiqar Bhutta, Johannes Sommerfeld, Zohra Lassi … (2014)

Infectious diseases of poverty (IDoP) disproportionately affect the poorest population in the world and contribute to a cycle of poverty as a result of decreased productivity ensuing from long-term illness, disability, and social stigma. In 2010, the global deaths from HIV/AIDS have increased to 1.5 million and malaria mortality rose to 1.17 million. Mortality from neglected tropical diseases rose to 152,000, while tuberculosis killed 1.2 million people that same year. Substantial regional variations exist in the distribution of these diseases as they are primarily concentrated in rural areas of Sub-Saharan Africa, Asia, and Latin America, with geographic overlap and high levels of co-infection. Evidence-based interventions exist to prevent and control these diseases, however, the coverage still remains low with an emerging challenge of antimicrobial resistance. Therefore, community-based delivery platforms are increasingly being advocated to ensure sustainability and combat co-infections. Because of the high morbidity and mortality burden of these diseases, especially in resource-poor settings, it is imperative to conduct a systematic review to identify strategies to prevent and control these diseases. Therefore, we attempted to evaluate the effectiveness of one of these strategies, that is community-based delivery for the prevention and treatment of IDoP. In this paper, we describe the burden, epidemiology, and potential interventions for IDoP. In subsequent papers of this series, we describe the analytical framework and the methodology used to guide the systematic reviews, and report the findings and interpretations of our analyses of the impact of community-based strategies on individual IDoPs.

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Patterns of presentation to the Australian and New Zealand Paediatric Emergency Research Network.

Meredith Borland, David Krieser, Sara E J Cotterell … (2009)

To describe epidemiological data concerning paediatric ED visits to an Australian and New Zealand research network. We conducted a cross-sectional study of paediatric ED visits to all Paediatric Research in Emergency Departments International Collaborative (PREDICT) sites in 2004. Epidemiological data, including demographics, admission rates and diagnostic grouping, were examined and analysed using descriptive and comparative statistical methods. We compared the data, if possible, with published data from a US paediatric emergency research network (Pediatric Emergency Care Applied Research Network). A total of 351 440 ED presentations were analysed from 11 PREDICT sites. Mean patient age was 4.6 years and 55% were boys. Presentations were identified as 3% Aboriginal at Australian sites and 44% Maori/Pacific in New Zealand locations. According to Australasian Triage Scale (ATS), 5% were ATS 1 or 2 (to be seen immediately or within 10 min), 27% ATS 3 (to be seen within 30 min) and 67% ATS 4 or 5. Although ED visits peaked in late winter and early spring, admission rates remained unchanged throughout the year with an overall admission rate of 24%. Most frequent diagnoses were acute gastroenteritis, acute viral illness and upper respiratory tract infection. Asthma was the next most common. Pediatric Emergency Care Applied Research Network and PREDICT data showed differences in terms of ethnicity descriptions/distribution and admission rates. This is the first description of the epidemiology of patient presentations to major paediatric ED in Australia and New Zealand. It details baseline data important to future collaborative studies and for planning health services for children.

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Journal

Journal ID (nlm-ta): Glob Pediatr Health

Journal ID (iso-abbrev): Glob Pediatr Health

Journal ID (publisher-id): GPH

Journal ID (hwp): spgph

Title: Global Pediatric Health

Publisher: SAGE Publications (Sage CA: Los Angeles, CA )

ISSN (Electronic): 2333-794X

Publication date (Electronic): 3 February 2021

Publication date Collection: 2021

Volume: 8

Electronic Location Identifier: 2333794X21991006

Affiliations

[1 ]Australian National University, Canberra, ACT, Australia

[2 ]University of Sydney, Sydney, NSW, Australia

[3 ]The Sydney Children’s Hospital Network, Westmead, NSW, Australia

[4 ]Australian National University, Woden, ACT, Australia

[5 ]The University of Western Australia, Perth, WA, Australia

[6 ]Marninwarntikura Women’s Resource Centre, Fitzroy Crossing, WA, Australia

[7 ]University of Notre Dame, Broome, WA, Australia

[8 ]Nindilingarri Cultural Health Services, Fitzroy Crossing, WA, Australia

[9 ]The University of Queensland, Brisbane, QLD, Australia

[10 ]University of Toronto, Toronto, ON, Canada

[11 ]The George Institute for Global Health, Sydney, NSW, Australia

Author notes

[*]Philippa Jane Dossetor, Australian Nation University Medical School Building 4, The Canberra Hospital, Hospital Rd, Garren, Canberra, ACT 2605, Australia. Email: philippa.dossetor@ 123456health.nsw.gov.au

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Philippa Jane Dossetor https://orcid.org/0000-0002-2226-0693

Article

Publisher ID: 10.1177_2333794X21991006

DOI: 10.1177/2333794X21991006

PMC ID: 7868448

PubMed ID: 33614847

SO-VID: 6ac06b63-9eca-42db-8344-ae1a12d08be4

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This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

History

Date received : 25 July 2020

Date revision received : 17 December 2020

Date accepted : 8 January 2021

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cover-date January-December 2021

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Keywords: aboriginal,emergency department presentation,pediatric,rural and remote,australia

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Keywords: aboriginal, emergency department presentation, pediatric, rural and remote, australia

Emergency Department Presentations by Children in Remote Australia: A Population-based Study

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Most cited references 25

The relationship between parent health literacy and pediatric emergency department utilization: a systematic review.

Global burden, distribution, and interventions for infectious diseases of poverty

Patterns of presentation to the Australian and New Zealand Paediatric Emergency Research Network.

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