title: Frequent users of the pediatric emergency department.
abstract: Emergency department (ED) crowding is associated with increased morbidity and mortality. Its etiology is multifactorial, and frequent ED use (defined as more or equal to five visits per year) is a major contributor to high patient volumes. Our primary objective is to characterize the frequent user population. Our secondary objective is to examine risk factors for frequent emergency use.
  
  
  
  We conducted a retrospective cohort study of pediatric emergency department (PED) visits at the Montreal Children's Hospital using the Système Informatique Urgence (SIURGE), electronic medical record database. We analysed the relation between patient's characteristics and the number of PED visits over a 1-year period following the index visit.
  
  
  
  Patients totalling 52,088 accounted for 94,155 visits. Of those, 2,474 (4.7%) patients had five and more recurrent visits and accounted for 16.6% (15,612 visits) of the total PED visits. Lower level of acuity at index visit (odds ratio [OR] 0.85) was associated with a lower number of recurrent visits. Lower socioeconomic status (social deprivation index OR 1.09, material deprivation index OR 1.08) was associated with a higher number of recurrent visits. Asthma (OR 1.57); infectious ear, nose, and sinus disorders (OR 1.33); and other respiratory disorders (OR 1.56) were independently associated with a higher incidence of a recurrent visit within the year following the first visit.
  
  
  
  Our study is the first Canadian study to assess risk factors of frequent pediatric emergency use. The identified risk factors and diagnoses highlight the need for future evidence-based, targeted innovative research evaluating strategies to minimize ED crowding, to improve health outcomes and to improve patient satisfaction.
authors.affiliation: *Division of Emergency Medicine,Department of Pediatrics,Montreal Children's Hospital,McGill University Health Centre,Montreal,QC.
authors.forename: Jade
authors.initials: J
authors.lastname: Seguin
authors.forename: Esli
authors.initials: E
authors.lastname: Osmanlliu
authors.affiliation: ‡Centre for Outcome Research and Evaluation,Research Institute,McGill University Health Centre,Montreal,QC.
authors.forename: Xun
authors.initials: X
authors.lastname: Zhang
authors.forename: Virginie
authors.initials: V
authors.lastname: Clavel
authors.affiliation: *Division of Emergency Medicine,Department of Pediatrics,Montreal Children's Hospital,McGill University Health Centre,Montreal,QC.
authors.forename: Harley
authors.initials: H
authors.lastname: Eisman
authors.affiliation: *Division of Emergency Medicine,Department of Pediatrics,Montreal Children's Hospital,McGill University Health Centre,Montreal,QC.
authors.forename: Robert
authors.initials: R
authors.lastname: Rodrigues
authors.affiliation: †Division of Pediatric Neurology,Department of Pediatrics,Montreal Children's Hospital,McGill University Health Centre,Montreal,QC.
authors.forename: Maryam
authors.initials: M
authors.lastname: Oskoui
mesh_terms: D000208:Acute Disease / Q000453:epidemiology / Q000628:therapy*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies
keywords: crowding; emergency services; frequent users; pediatric emergency department