Who attends a Children's Hospital Emergency Department for dental reasons? A two-step cluster analysis approach.
OBJECTIVE
Emergency departments (EDs) have been identified as key providers of dental care although few studies have examined patterns of attendance or clusters of characteristics. The aim was to identify the reasons for visits to an ED, whether these remained stable over time, and characterize clusters of patients by socio-demographic and attendance variables.


METHODS
Pseudonymized data were obtained for children who attended the ED in 2003-2004, 2004-2005 and 2012-2013. Presenting complaint was categorized as attending for dental or nondental reasons. Other variables analysed included patient (age, sex, ethnicity and deprivation) and attendance characteristics (distance travelled, season, nature of complaint, time elapsed since onset of symptoms, day of week and hours of attendance), together with treatment outcome (advice, antibiotics and referral). To assess trends over time, analyses were conducted on patient, attendance and treatment outcome variables. To examine whether patients could be characterized by socio-demographic and attendance variables, a two-step cluster analysis was undertaken on 2003-2004 data set and validated on 2004-2005 and 2012-2013 data sets.


RESULTS
In 2003-2004, 550 children attended the ED for dental reasons rising to 687 in 2012-2013. The most important predictors of dental attendance were as follows: nature of complaint, ethnicity, time elapsed, sex and deprivation of the area in which children lived. The analysis showed two clusters: cluster 1 was comprised of children who attended the ED for dental injury, were of White ethnicity and attended within 24 h of onset of symptoms. Children in this cluster were likely to be from the least or less deprived areas (compared to Cluster 2) and were more likely to be males. Cluster 2 comprised of children attending the ED for caries, oral mucosal lesions or other complaints, were likely to be of other (non-White) ethnicities and were likely to attend more than 24 h after symptoms began. Children in this cluster were more likely to come from the most deprived areas and were both males and females. The clusters varied according to treatment outcome; those patients in Cluster 2 were more likely to be prescribed medication, whilst those children in Cluster 1 were more likely to be referred to another specialty.


CONCLUSIONS
A significant number of visits to the ED were for dental reasons with two clusters of children. The results have identified groups of patients for whom appropriate dental provision is lacking and where targeted services are needed to improve outcomes for children and reduce the burden on EDs.
School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
Z
Z
Marshman
School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
T
T
Broomhead
School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
H D
HD
Rodd
Public Health England, Sheffield, UK.
K
K
Jones
Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, UK.
D
D
Burke
School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
S R
SR
Baker
health services research; pediatric dentistry
Hosseinpoor AR, Itani L, Petersen PE. Socio-economic inequality in oral healthcare coverage: results from the world health survey. J Dent Res 2012;91:275-81.
Devaux M. Income-related inequalities and inequities in health care services utilisation in 18 selected OECD countries. Eur J Health Econ 2015;16:21-33.
Cohen LA, Manski RJ, Magder LS, Mullins CD. Dental visits to hospital emergency departments by adults receiving medicaid - assessing their use. J Am Dent Assoc 2002;133:715-24.
Cohen LA, Manski RJ. Visits to non-dentist health care providers for dental problems. Fam Med 2006;38:556-64.
Okunseri C, Okunseri E, Thorpe JM, Xiang Q, Szabo A. Patient characteristics and trends in nontraumatic dental condition visits to emergency departments in the United States. Clin Cosmet Investig Dent 2012;4:1-7.
Walker A, Probst JC, Martin AB, Bellinger JD, Merchant A. Analysis of hospital-based emergency department visits for dental caries in the United States in 2008. J Public Health Dent 2014;74:188-94.
Allareddy V, Rampa S, Lee MK, Allareddy V, Nalliah RP. Cover story hospital-based emergency department visits involving dental conditions profile and predictors of poor outcomes and resource utilization. J Am Dent Assoc 2014;145:331-7.
Cohen LA, Bonito AJ, Eicheldinger C, Manski RJ, Macek MD, Edwards RR et al. Comparison of patient visits to emergency departments, physician offices, and dental offices for dental problems and injuries. J Public Health Dent 2011;71:13-22.
Quinonez C. Self-reported emergency room visits for dental problems. Int J Dent Hyg 2011;9:17-20.
Quinonez C, Gibson D, Jokovic A, Locker D. Emergency department visits for dental care of nontraumatic origin. Community Dent Oral Epidemiol 2009;37:366-71.
Lee HH, Lewis CW, Saltzman B, Starks H. Visiting the emergency department for dental problems: trends in utilization 2001 to 2008. Am J Public Health 2012;102:e77-83.
Wall T, Nasseh K. Dental-related emergency department visits on the increase in the United States. In: Institute HP, editor. Research brief. Chicago, Illinois: American Dental Association, 2013; 1-9.
Lewis C, Lynch H, Johnston B. Dental complaints in emergency departments: a national perspective. Ann Emerg Med 2003;42:93-9.
Rowley ST, Sheller B, Williams BJ, Mancl L. Utilization of a hospital for treatment of pediatric dental emergencies. Pediatr Dent 2006;28:10-7.
Von Kaenel D, Vitangeli D, Casamassimo PS, Wilson S, Preisch J. Social factors associated with pediatric emergency department visits for caries-related dental pain. Pediatr Dent 2001;23:56-60.
McCormick AP, Abubaker AO, Laskin DM, Gonzales MS, Garland S. Reducing the burden of dental patients on the busy hospital emergency department. J Oral Maxillofac Surg 2013;71:475-8.
Cohen LA, Harris SL, Bonito AJ, Manski RJ, Macek MD, Edwards RR et al. Low-income and minority patient satisfaction with visits to emergency departments and physician offices for dental problems. J Am Coll Dent 2009;76:23-31.
Griffin B, Sherman KA, Jones M, Bayl-Smith P. The clustering of health behaviours in older australians and its association with physical and psychological status, and sociodemographic indicators. Ann Behav Med 2014;48:205-14.
Chan MF, Wong FK, Chang K, Chow S, Chung L, Lee WM et al. Identifying patient readmission subtypes from unplanned readmissions to hospitals in Hong Kong: a cluster analysis. Nurs Health Sci 2009;11:37-44.
Fleury MJ, Grenier G, Bamvita JM. Predictive typology of subjective quality of life among participants with severe mental disorders after a five-year follow-up: a longitudinal two-step cluster analysis. Health Qual Life Outcomes 2015;13:150.
Norusis MJ. IBM SPSS statistics 19 procedures companion. Texas, USA: Addison Wesley, 2011.
Kaufman L. Finding groups in data: an introduction to cluster analysis. Hoboken, New Jersey, USA: Wiley Blackwell Publishing Ltd, 2005.
Health and Social Care Information Centre. Report 1: attitudes, behaviours and children's dental health in England, Wales and Northern Ireland. Child Dental Health Survey 2015;2013.
Sheffield City Council. Population and health of Sheffield (2013). Sheffield, UK: Sheffield City Council, 2013.
Public Health England. Oral health survey of three-year-old children 2013: A report on the prevalence and severity of dental decay. Dental Public Health Epidemiology Programme 2014.
Çolak H, Dülgergil T, Dalli M, Hamidi M. Early childhood caries update: a review of causes, diagnoses, and treatments. J Nat Sci Biol Med 2013;4:29-38.
Zaitoun H, North S, Lee S, Albadri S, McDonnell ST, Rodd HD. Initial management of paediatric dento-alveolar trauma in the permanent dentition: a multi-centre evaluation. Br Dent J 2010;208:E11. doi:10.1038/sj.bdj.2010.254
Andersen RM. Revisiting the behavioural model and access to medical care: does it matter? J Health Soc Behav 1995;36:1-10.
Nilsen P. Making sense of implementation theories, models and frameworks. Implement Sci 2015;10:53.
Cope AL, Chestnutt IG. Inappropriate prescribing of antibiotics in primary dental care: reasons and resolutions. Prim Dent J 2014;3:33-7.