title: [Frequent users in paediatric emergency departments. Who are they? Why do they consult?]
abstract: OBJECTIVE
  To determine the prevalence of frequent Paediatric Emergency Departments users and to analyse their characteristics, comparing initial consultations and re-consultations.
  
  
  METHODS
  This is a multicentre retrospective cohort study of all patients who made 10 or more visits to the Paediatric Emergency Departments of 5 public hospitals between 1 January 2013 and 31 December 2013. An analysis was performed on the patient demographics and clinical data of the first consultation and consecutive re-consultations.
  
  
  RESULTS
  Frequent users represented 0.60% (95% CI: 0.56-0.64%) of Emergency Department users, and accounted for 3.93% (95% CI: 3.47-4.39%) of all visits. The most numerous age group consisted of children under 2 years old (66.6%). Frequent users distributed their visits throughout the year (62.3%; P<.001), and did not have a chronic condition associated with their chief complaint (86.4%; P<.001). They were usually classified as non-urgent or less urgent in triage (3,186 vs. 1,812; P<.001), and often did not require any intervention, such as complementary tests (79.4%) or observation/treatment (60%). Admission rate was similar to the general paediatric population (5.3%). Re-consultations represented 27% of these patient visits, mostly related to persistence of symptoms (56.3%), with 13.8% of them consulting their Primary Care physician before seeking successive medical attention in the Paediatric Emergency Department.
  
  
  CONCLUSIONS
  Paediatric frequent users often ask for medical care in the Emergency Department before consulting their Primary Care physician. They present with less urgent processes and do not systematically need diagnostic or therapeutic interventions. Re-consultations make up a significant number of visits, in which more interventions are done and more children are admitted.
authors.affiliation: Hospital Universitario Gregorio Marañón, Madrid, España. Electronic address: arisrivas@hotmail.com.
authors.forename: Arístides
authors.initials: A
authors.lastname: Rivas García
authors.affiliation: Hospital Universitario Gregorio Marañón, Madrid, España.
authors.forename: Gema
authors.initials: G
authors.lastname: Manrique Martín
authors.affiliation: Hospital Universitario Gregorio Marañón, Madrid, España.
authors.forename: Laura
authors.initials: L
authors.lastname: Butragueño Laiseca
authors.affiliation: Hospital Universitario Doce de Octubre, Madrid, España.
authors.forename: Sofía
authors.initials: S
authors.lastname: Mesa García
authors.affiliation: Hospital Universitario de Getafe, Getafe, Madrid, España.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Campos Segura
authors.affiliation: Hospital Universitario Infanta Cristina, Parla, Madrid, España.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Fernández Iglesia
authors.affiliation: Hospital Universitario del Tajo, Aranjuez, Madrid, España.
authors.forename: Rubén
authors.initials: R
authors.lastname: Moreno Sánchez
authors.affiliation: Hospital Universitario La Princesa, Madrid, España.
authors.forename: Juan Mariano
authors.initials: JM
authors.lastname: Aguilar Mulet
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D000069342:Medical Overuse / Q000706:statistics & numerical data*; D012017:Referral and Consultation; D012189:Retrospective Studies; D013030:Spain; D014505:Urban Population
keywords: Frequent user; Hiperfrecuentador; Paediatric emergency department; Re-consultation; Reconsulta; Urgencias de pediatría