RESUMO
BACKGROUND: Little is known about the characteristics, clinical course, and the disposition of sick children transferred from pediatricians' offices to the emergency department (ED). OBJECTIVES: The purpose of the study was to determine the clinical profile, ED course, and disposition of children transferred from a hospital-based pediatric clinic to the ED. METHODS: We conducted a retrospective cohort study involving all sick children transferred from a hospital-based clinic to the hospital's ED from January 2012 to December 2013. Data collected included demographics, acuity of illness, ED course, diagnoses, and disposition of all children. RESULTS: A total of 179 patients were transferred to and received care in the ED: boys, 56%; median age, 18 months; mean age, 58 months; 68% were younger than 60 months; African American, 83%; Hispanic, 12%. Sixty-eight percent of the patients were triaged as Emergency Severity Index 3 (urgent) and 13% were Emergency Severity Index 2 (high risk), with the rest categorized as nonurgent. Forty-three percent (78) were discharged home, and 57% were admitted. Age younger than 60 months, need for intravenous antibiotics, inhaled medications, plain x-rays, respiratory viral panel polymerase chain reaction (PCR), supplemental oxygen, and blood work in the ED were associated with being admitted (P < 0.05). The top 3 primary diagnoses were respiratory distress (40%), skin and soft tissue infections (15%), and other infections (10%). CONCLUSIONS: Children transferred from a hospital-based pediatric clinic to the ED at an urban academic medical center had a high level of acuity, and almost 60% were admitted for inpatient care. Improvement in the provision of pretransfer care can potentially decrease transfers to the ED.