How Many Transfers to Tertiary Pediatric EDs Are Unnecessary?


In a large study of children transferred to pediatric emergency departments in the U.S., 25% were directly discharged.

In a cross-sectional study of 22,891 emergency department (ED) patients <18 years of age (mean age, 6 years) transferred to 29 U.S. tertiary pediatric hospitals during 1 year, investigators examined common diagnoses and management of those who were discharged directly or admitted for <24 hours.

Of the 5645 patients who were discharged directly from the tertiary ED, 21% required no additional testing, procedures, or medications. An additional 33% received only acetaminophen, ibuprofen, ondansetron, or plain radiographs. The top five diagnostic categories for patients discharged directly were orthopedic problems (16%), nonsurgical abdominal pain (6%), viral gastroenteritis and dehydration (6%), gastrointestinal illness (5%), and traumatic head injury (5%). The authors recommend educational efforts for general ED providers about common pediatric complaints.

Comment: The authors erroneously (and arrogantly) failed to include in the study’s limitations the complete lack of follow-up data on discharged patients. Rather, they assumed no adverse outcomes and used the clinical impression of the physician at the tertiary pediatric ED as its own gold standard. These results may be useful to advocate for more pediatric-specific resources and specialty services across the U.S., but should not be used to preach about the (unfounded) ignorance of general ED providers.

Source: Journal Watch Emergency Medicine.

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