Exploring factors associated with high frequency emergency department use by children and young people: a retrospective cohort study

Objective To explore drivers of high frequency emergency department (ED) use by children and young people, particularly among those attending EDs most often.

Design A population-based retrospective cohort study using routinely collected linked healthcare data.

Setting EDs in the Yorkshire and Humber region of the UK.

Patients 288 545 children and young people aged 17 and under making at least one ED attendance in the year period 1 April 2016 to 31 March 2017.

Main outcome measures ED attendances made by individuals in the year period.

Results Of the 288 545 distinct children and young people making at least one attendance to an ED, 27 560 (9.6%) were defined as high frequency ED attenders (making 3+attendances in the year) and accounted for 105 063 (25%) ED attendances in the study period. When considering factors associated with ED attendance rates, younger age groups and greater levels of deprivation were found to be associated with higher rates of attendance. This association was amplified in those attending the ED most often. Ethnicity was found to be associated with ED attendance rates, with those reported as mixed and other ethnicities displaying greater rates of attendance than those reported as white and those reported as black ethnicity displaying lower attendance rates in comparison to those reported as white. The interaction between an individual’s deprivation and ethnic status generally displayed lower rates of attendance in ethnic minorities belonging to the most deprived category.

Conclusions When seeking to reduce frequent ED attendance by children and young people this study highlights the need for any approach to be multifaceted, nuanced to age or condition specifics and consider social determinants that drive ED use in more deprived areas.