Characteristics of frequently attending children in hospital emergency departments: a systematic review

Greenfield, Geva; Okoli, Olivia; Quezada-Yamamoto, Harumi; Blair, Mitch; Saxena, Sonia; Majeed, Azeem; Hayhoe, Benedict

OBJECTIVE: To summarise the literature on frequent attendances to hospital emergency departments (EDs) and describe sociodemographic and clinical characteristics of children who attend EDs frequently. SETTING: Hospital EDs. PARTICIPANTS: Children <21 years, attending hospital EDs frequently. PRIMARY OUTCOME MEASURES: Outcomes measures were defined separately in each study, and were predominantly the number of ED attendances per year. RESULTS: We included 21 studies representing 6 513 627 children. Between 0.3% and 75% of all paediatric ED users were frequent users. Most studies defined four or more visits per year as a ‘frequent ED’ usage. Children who were frequent ED users were more likely to be less than 5 years old. In the USA, patients with public insurance were more likely to be frequent attenders. Frequent ED users more likely to be frequent users of primary care and have long-term conditions; the most common diagnoses were infections and gastroenteritis. CONCLUSIONS: The review included a wide range of information across various health systems, however, children who were frequent ED users have some universal characteristics in common. Policies to reduce frequent attendance might usefully focus on preschool children and supporting primary care in responding to primary care oriented conditions.