"Left without being seen": a national profile of children who leave the emergency department before evaluation.
OBJECTIVE
The epidemiology of children who present to the emergency department (ED) and leave without being seen has not been well characterized. We evaluate rates and secular trends of children who leave without being seen, identify factors associated with pediatric leave without being seen cases, and determine whether there are differences in leaving patterns between children and adults seeking emergency care.


METHODS
Data were obtained from the National Hospital Ambulatory Medical Care Survey, which collects information on patient visits to EDs throughout the United States. We examined data for children (less than or equal to 18 years of age) and adults who presented to EDs during the 6-year period ending in 2005.


RESULTS
During the study period, there were an estimated 11,848,351 leave without being seen visits nationally, accounting for 1.79% of all ED visits. The prevalence of leaving without being seen was 2.46% (95% confidence interval [CI] 1.71% to 3.55%) for pediatric patients presenting to pediatric EDs, 1.86% (95% CI 1.65% to 2.10%) for pediatric patients presenting to general EDs, and 1.73% (95% CI 1.57% to 1.91%) for adults presenting to general EDs. The leave without being seen rates did not increase significantly during the study period. Factors associated with leave without being seen visits included hospital urban location, self-pay insurance status, and less acute triage level for children and adults, as well as race/ethnicity and arrival time for adult patients.


CONCLUSIONS
In this national sample of patients, leave without being seen rates were similar for pediatric and adult patients and did not increase during the 6-year study period, although some variation in rates was observed for specific patient and ED characteristics. These national estimates provide an important reference for institutions to assess their ED performance.
Bourgeois
Florence T
FT
Division of Emergency Medicine, Children's Hospital Boston, Boston, MA 02115, USA. florence.bourgeois@childrens
Shannon
Michael W
MW
Stack
Anne M
AM
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003441:Crowding; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009309:National Center for Health Statistics, U.S.; D010352:Patient Dropouts / Q000523:psychology / Q000706:statistics & numerical data*; D010372:Pediatrics / Q000706:statistics & numerical data*; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D014481:United States; D014850:Waiting Lists; D055815:Young Adult