title: Is the emergency department an appropriate substitute for primary care for persons with traumatic spinal cord injury?
abstract: METHODS
  Retrospective cohort with linkage of administrative data sets.
  
  
  OBJECTIVE
  To describe the patterns (for example, number of visits by year post-injury) and characteristics of the emergency department (ED) visits (for example, acuity level, timing of visits, reasons for visits) made by persons with traumatic spinal cord injury (TSCI) over a 6-year period following injury.
  
  
  METHODS
  Ontario, Canada.
  
  
  METHODS
  Rates of ED utilization and reasons for ED visits were calculated between the fiscal years 2003-2009. Reasons for visits were categorized by acuity level: potentially preventable visits were defined as visits related to ambulatory sensitive conditions; low acuity and high acuity visits were defined by the Canadian Triage and Acuity Scale.
  
  
  RESULTS
  The total number of ED visits for the 6-year period is 4403 (n=1217). Of these visits, 752 (17%) were classified as potentially preventable, 1443 (33%) as low acuity and 2208 (50%) as high acuity. The majority of patients, regardless of acuity level, did not see a primary care practitioner on the day of the ED visit and most visits occurred during the weekday (Mon-Fri 0700-1659 hours). ED use was highest in the first year but remained high over the subsequent years. For potentially preventable visits, the majority of visits were related to urinary tract infections (n=385 visits, 51.2%), followed by pneumonia (n=91, 12.1%).
  
  
  CONCLUSIONS
  Given the high rates of ED use for low acuity and potentially preventable conditions, these results suggest that the ED is being used as an inappropriate substitute for primary care for individuals with TSCI 50% of the time.
authors.affiliation: Institute of Health, Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. sara.guilcher@utoronto.ca
authors.forename: S J T
authors.initials: SJ
authors.lastname: Guilcher
authors.forename: B C
authors.initials: BC
authors.lastname: Craven
authors.forename: A
authors.initials: A
authors.lastname: Calzavara
authors.forename: M A
authors.initials: MA
authors.lastname: McColl
authors.forename: S B
authors.initials: SB
authors.lastname: Jaglal
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000706:statistics & numerical data* / Q000639:trends; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011320:Primary Health Care / Q000706:statistics & numerical data* / Q000639:trends; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*