Factors predictive of hospital admission for children via emergency departments in Australia and Sweden: an observational cross-sectional study.

ABSTRACT

BACKGROUND: Identifying factors predictive of hospital admission can be useful to prospectively inform bed management and patient flow strategies and decrease emergency department (ED) crowding. It is largely unknown if admission rate or factors predictive of admission vary based on the population to which the ED served (i.e., children only, or both adults and children). This study aimed to describe the profile and identify factors predictive of hospital admission for children who presented to four EDs in Australia and one ED in Sweden. METHODS: A multi-site observational cross-sectional study using routinely collected data pertaining to ED presentations made by children < 18 years of age between July 1, 2011 and October 31, 2012. Univariate and multivariate analysis were undertaken to determine factors predictive of hospital admission. RESULTS: Of the 151,647 ED presentations made during the study period, 22% resulted in hospital admission. Admission rate varied by site; the children's EDs in Australia had higher admission rates (South Australia 26%, Queensland 23%) than the mixed (adult and children's) EDs (South Australia 13%, Queensland 17%, Sweden 18%). Factors most predictive of hospital admission for children, after controlling for triage category, included hospital type (children's only) adjusted odds ratio (aOR)2.3 (95%CI 2.2-2.4), arrival by ambulance aOR2.8 (95%CI 2.7-2.9), referral from primary health aOR1.5 (95%CI 1.4-1.6) and presentation with a respiratory or gastrointestinal condition (aOR2.6, 95%CI 2.5-2.8 and aOR1.5, 95%CI 1.4-1.6, respectively). Predictors were similar when each site was considered separately. CONCLUSIONS: Although the characteristics of children varied by site, factors predictive of hospital admission were mostly similar. The awareness of these factors predicting the need for hospital admission can support the development of clinical pathways.