title: Tertiary paediatric emergency department use in children and young people with cerebral palsy.
abstract: OBJECTIVE
  The aim of this study was to describe the pattern of tertiary paediatric emergency department (ED) use in children and young people with cerebral palsy (CP).
  
  
  METHODS
  A retrospective analysis of ED data routinely collected at the two tertiary paediatric hospitals in Victoria, Australia, cross-matched with the Victorian Cerebral Palsy Register. Data pertaining to the ED presentations of 2183 registered individuals born 1993-2008 were obtained.
  
  
  RESULTS
  Between 2008 and 2012, 37% (n = 814) of the CP cohort had 3631 tertiary paediatric ED presentations. Overall, 40% (n = 332) of presenters were residing in inner metropolitan Melbourne; 44% (n = 356) in outer Melbourne; and 13% (n = 108) in regional Victoria. Presenters were more likely than non-presenters to be younger, non-ambulant and have epilepsy. In total, 71% of presentations were triaged as Australasian Triage Scale 1-3 (urgent), and 44% resulted in a hospital admission. Disorders of the respiratory, neurological and gastrointestinal systems, and medical device problems were responsible for 72% of presentations.
  
  
  CONCLUSIONS
  Many of the tertiary paediatric ED presentations in this group were appropriate based on the high admission rate and the large proportion triaged as urgent. However, there is evidence that some families are bypassing local services and travelling long distances to attend the tertiary paediatric ED, even for less urgent complaints that do not require hospital admission. Alternative pathways of care delivery, and strategies to promote the management of common problems experienced by children and young people with CP in non-paediatric EDs or primary care settings, may go some way towards reducing unnecessary tertiary paediatric ED use in this group.
authors.affiliation: Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.|Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
authors.forename: Elaine
authors.initials: E
authors.lastname: Meehan
authors.affiliation: Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.|Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Reid
authors.affiliation: Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.|Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.|Developmental Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Katrina
authors.initials: K
authors.lastname: Williams
authors.affiliation: Health Systems and Workforce Unit, Centre for Health Policy, School of Global and Population Health, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Gary L
authors.initials: GL
authors.lastname: Freed
authors.affiliation: Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.|Emergency Research, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.|Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Franz E
authors.initials: FE
authors.lastname: Babl
authors.affiliation: Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.|Policy, Equity and Translation Research, Population Health, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.|Centre for Community Child Health, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Jillian R
authors.initials: JR
authors.lastname: Sewell
authors.affiliation: Paediatric Rehabilitation, Monash Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Barry
authors.initials: B
authors.lastname: Rawicki
authors.affiliation: Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.|Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.|Developmental Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Dinah S
authors.initials: DS
authors.lastname: Reddihough
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D010343:Patient Admission; D012042:Registries; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*; D014218:Triage; D014739:Victoria / Q000453:epidemiology
keywords: cerebral palsy; emergency services; hospitals; paediatric; primary health care