title: Unfavourable outcome for children leaving the emergency department without being seen by a physician.
abstract: OBJECTIVE
  To assess the prevalence of an unfavourable outcome among children leaving without being seen by a physician in the emergency department (ED).
  
  
  METHODS
  This was a prospective cohort study conducted over a complete year in a pediatric tertiary care ED. A random sample of all children younger than 19 years of age who left without being seen by a physician was contacted by phone 4 to 6 days following the ED visit. The primary outcome was the occurrence of an unfavourable outcome prospectively defined using a Delphi method among 15 pediatric emergency physicians. An unfavourable outcome was defined as hospitalization, the need for an invasive procedure (intravenous or intramuscular medication, fracture reduction, bone casting, or surgical intervention), suicide attempt, or death in the 72 hours following leaving without being seen by a physician. As a secondary outcome, multiple potential predictors were evaluated. The first analysis evaluated the proportion of unfavourable outcomes among children who left without being seen by a physician. Then logistic regression identified predictors of unfavourable outcomes.
  
  
  RESULTS
  During the study period, 61,909 children presented to the ED, 7,592 (12%) left without being seen by a physician, and 1,579 were recruited. Thirty-eight (2.4%; 95% CI 1.7-3.2) patients fulfilled the criteria for an unfavourable outcome. On multiple logistic regression, chief complaints related to trauma and absence of nurse counseling had higher risks of unfavourable outcome.
  
  
  CONCLUSIONS
  Approximately 2% of children who left without being seen by a physician at a tertiary care pediatric ED had an unfavourable outcome.
authors: Jocelyn
authors: J
authors: Gravel
authors: Serge
authors: S
authors: Gouin
authors: Benoit
authors: B
authors: Carrière
authors: Nathalie
authors: N
authors: Gaucher
authors: Benoit
authors: B
authors: Bailey
mesh_terms: D002648:Child; D002675:Child, Preschool; D003376:Counseling; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D017063:Outcome Assessment, Health Care; D010352:Patient Dropouts; D011446:Prospective Studies; D014218:Triage / Q000379:methods*