title: Can linked emergency department data help assess the out-of-hospital burden of acute lower respiratory infections? A population-based cohort study.
abstract: BACKGROUND
  There is a lack of data on the out-of-hospital burden of acute lower respiratory infections (ALRI) in developed countries. Administrative datasets from emergency departments (ED) may assist in addressing this.
  
  
  METHODS
  We undertook a retrospective population-based study of ED presentations for respiratory-related reasons linked to birth data from 245,249 singleton live births in Western Australia. ED presentation rates <9 years of age were calculated for different diagnoses and predictors of ED presentation <5 years were assessed by multiple logistic regression.
  
  
  RESULTS
  ED data from metropolitan WA, representing 178,810 births were available for analysis. From 35,136 presentations, 18,582 (52.9%) had an International Classification of Diseases (ICD) code for ALRI and 434 had a symptom code directly relating to an ALRI ICD code. A further 9600 presentations had a non-specific diagnosis. From the combined 19,016 ALRI presentations, the highest rates were in non-Aboriginal children aged 6-11 months (81.1/1000 child-years) and Aboriginal children aged 1-5 months (314.8/1000). Croup and bronchiolitis accounted for the majority of ALRI ED presentations. Of Aboriginal births, 14.2% presented at least once to ED before age 5 years compared to 6.5% of non-Aboriginal births. Male sex and maternal age <20 years for Aboriginal children and 20-29 years for non-Aboriginal children were the strongest predictors of presentation to ED with ALRI.
  
  
  CONCLUSIONS
  ED data can give an insight into the out-of-hospital burden of ALRI. Presentation rates to ED for ALRI were high, but are minimum estimates due to current limitations of the ED datasets. Recommendations for improvement of these data are provided. Despite these limitations, ALRI, in particular bronchiolitis and croup are important causes of presentation to paediatric EDs.
authors.affiliation: Division of Population Sciences, Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Australia. hannahm@ichr.uwa.edu.au
authors.forename: Hannah C
authors.initials: HC
authors.lastname: Moore
authors.forename: Nicholas
authors.initials: N
authors.lastname: de Klerk
authors.forename: Peter
authors.initials: P
authors.lastname: Jacoby
authors.forename: Peter
authors.initials: P
authors.lastname: Richmond
authors.forename: Deborah
authors.initials: D
authors.lastname: Lehmann
mesh_terms: D000208:Acute Disease; D000328:Adult; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003625:Data Collection; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000523:psychology; D007223:Infant; D016015:Logistic Models; D008297:Male; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000706:statistics & numerical data; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D014504:Urban Health; D014904:Western Australia / Q000453:epidemiology; D055815:Young Adult