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August 1993

Advice Seeking and Appropriate Use of a Pediatric Emergency Department

Author Affiliations

From the Department of Developmental and Behavioral Pediatrics, Children's Hospital, Boston, Mass (Dr Oberlander), the Departments of Pediatrics and Epidemiology, McGill University, Montreal, Quebec (Drs Pless and Dougherty), and the Department of Pediatrics, Montreal Children's Hospital (Dr Dougherty). Dr Oberlander is now with the Department of Pediatrics, Montreal Children's Hospital.

Am J Dis Child. 1993;147(8):863-867. doi:10.1001/archpedi.1993.02160320065021

• Objectives.  —To determine whether seeking advice prior to an unscheduled visit to a pediatric emergency department (PED) influences appropriate use of this setting for minor illnesses.

Design.  —Cross-sectional questionnaire survey.

Setting.  —The medical emergency department of the Montreal (Quebec) Children's Hospital, a major referral and urban teaching hospital.

Participants.  —Four hundred eighty-nine of 562 consecutive parents visiting the PED over two periods, one in February and the other in July 1989.

Interventions.  —None.

Measurements/Main Results.  —Parents of children between 0 and 18 years of age visiting the PED were asked whether they had previously sought advice from family, friends, or a physician. Other factors possibly related to the decision to seek care were also measured. Appropriateness was rated, blind to discharge diagnosis, by two pediatricians using a structured series of questions incorporating the child's age, time of the visit, clinical state, and problem at presentation. Thirty-four percent of visits among respondents were judged appropriate. In bivariate analysis, appropriate visits occurred significantly more often when a parent spoke to both a physician and a nonphysician (47%) prior to visiting the PED than when no advice was sought (29%; P<.05). In multivariate analysis, having a regular physician and being one of two children also contributed to appropriateness.

Conclusions  —Appropriate use of the PED was positively influenced by seeking prior advice from both a physician and family member, having a regular physician, and having prior child care experience.(AJDC. 1993;147:863-867)

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