title: Determining the common medical presenting problems to an accident and emergency department.
abstract: All accident and emergency (A&E) attendances over a one year period were prospectively studied in order to determine common medical presenting problems. Data were collected on children (0-15 years) attending a paediatric A&E department in Nottingham between February 1997 and February 1998. A total of 38 982 children were seen. The diagnoses of 26 756 (69%) were classified as trauma or surgical, and 10 369 (27%) as medical; 1857 (4%) could not be classified. The commonest presenting problems reported for "medical" children were breathing difficulty (31%), febrile illness (20%), diarrhoea with or without vomiting (16%), abdominal pain (6%), seizure (5%), and rash (5%). The most senior doctor seeing these patients in A&E was a senior house officer (intern or junior resident) in 78% of cases, paediatric registrar (senior resident) in 19%, consultant (attending physician) in 1.4%, and "other" in 2.6%. Guidelines developed for A&E should target the commonest presenting problem categories, six of which account for 83% of all medical attendances, and be directed towards senior house officers.
authors.affiliation: Academic Division of Child Health, School of Human Development, Medical Faculty, University of Nottingham, Nottingham NG7 2UH, UK. mk.armon@ntlworld.com
authors.forename: K
authors.initials: K
authors.lastname: Armon
authors.forename: T
authors.initials: T
authors.lastname: Stephenson
authors.forename: V
authors.initials: V
authors.lastname: Gabriel
authors.forename: R
authors.initials: R
authors.lastname: MacFaul
authors.forename: P
authors.initials: P
authors.lastname: Eccleston
authors.forename: U
authors.initials: U
authors.lastname: Werneke
authors.forename: S
authors.initials: S
authors.lastname: Smith
mesh_terms: D000208:Acute Disease / Q000628:therapy*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004739:England; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008505:Medical Staff, Hospital; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies