The Relationship between the Mode of Arrival at Pediatric Emergency Department and Severity in Age Categories in Japan

Background: Diseases, severity, or parents’ anxiety differ according to the age in childhood. Although the age may influence the mode of arrival at an emergency department (ED) and disposition, the hospitalization rate by the mode of arrival in each age category is unclear yet.

Purpose: To clarify the relationship between the mode of arrival at ED and the admission rate in each age category in Japan.

Methods: A retrospective cohort study was performed for patients under age of 18 years who visited ED at two pediatric tertiary hospitals in Japan from August 2014 through September 2016. These patients were classified into 6 age categories: group1 as birth to 28 days; group 2 as 29 days to 12 months; group3 as 13 months to 2 years; group 4 as 3 to 5 years; group 5 as 6 to 11 years; and group 6 as 12 to 18 years. The mode of arrival at ED and rate of admission to wards were examined.

Results: A total of 140,412 cases were eligible, with group 1 0.7%, group 2 14.0%, group 3 29.9%, group 4 18.8%, group 5 28.9%, and group 6 7.7%, respectively. Patients who arrived by ambulance for each age group occupied 17.8%, 8.6%, 10.7%, 8.9%, 8.7%, and 11.5%, respectively. The admission rate in patients who arrived by walk-in and ambulance for each age group was 8.6% vs. 51.2% (OR 11.2, 95% CI 7.6 – 16.5), 5.1% vs. 23.8% (OR 5.8, 95% CI 5.1 – 6.7), 3.4% vs. 8.8% (OR 2.7, 95% CI 2.4 – 3.2) , 2.8% vs. 8.7% (OR 3.3, 95% CI 3.0 – 3.7), 2.9% vs. 10.1% (OR 3.7, 95% CI 3.2 – 4.3), and 3.6% vs. 9.4% (OR 2.8, 95% CI 2.2 – 3.4), respectively.

Conclusion: Patients who arrived by ambulance were more frequently in group 1 and the admission rate was higher in group 1 and 2 in Japan.