Emergency department wait times

Longitudinal trends in incidence and health care use for pediatric concussion in Alberta, Canada

BACKGROUND

We described longitudinal trends in the incidence of episodes of care (EOC) and follow-up care for pediatric concussion in relation to age, sex, rurality of patient residence, point of care, and area-based socioeconomic status (SES) in Alberta, Canada.

METHODS

A retrospective population-based cohort study was conducted using linked, province-wide administrative health data for all patients <18 years of age who received a diagnosis of concussion, other specified injuries of head, unspecified injury of head, or post-concussion syndrome between April 1, 2004 and March 31, 2018. Data were geospatially mapped.

RESULTS

Concussion EOCs increased 2.2-fold over the study period, follow-up visits 5.1-fold. Care was increasingly received in physician office (PO) settings. Concussion diagnoses in rural and remote areas occurred in emergency department (ED) settings more often than in metro centres or urban areas (76%/75% vs. 52%/60%). Proportion of concussion diagnoses was positively related to SES and age. Diagnosis and point of care varied geographically.

CONCLUSIONS

The shift in care to PO settings, increased incidence of all diagnoses, and the higher use of the ED by some segments of the population all have important implications for appropriate clinical management and the efficient provision of health care for pediatric concussion.

IMPACT

This is the first study to use EOC to describe longitudinal trends in incidence and follow-up care for pediatric concussion in relation to age, sex, rurality, point of care, and area-based SES. We report increased incidence of concussion in both emergency and outpatient settings and the proportion of diagnoses was positively related to SES and age. Patients increasingly received care for concussion in PO over time. Geospatial mapping indicated that the incidence of concussion and unspecified injury of head varied geographically and temporally. Results have important implications for appropriate clinical management and efficient provision of health care following pediatric concussion.

Variation in emergency department wait times for children by race/ethnicity and payment source

OBJECTIVE

To quantify the variation in emergency department (ED) wait times by patient race/ethnicity and payment source, and to divide the overall association into between- and within-hospital components.

DATA SOURCE

2005 and 2006 National Hospital Ambulatory Medical Care Surveys.

STUDY DESIGN

Linear regression was used to analyze the independent associations between race/ethnicity, payment source, and ED wait times in a pooled cross-sectional design. A hybrid fixed effects specification was used to measure the between- and within-hospital components.

DATA EXTRACTION METHODS

Data were limited to children under 16 years presenting at EDs.

PRINCIPAL RESULTS

Unadjusted and adjusted ED wait times were significantly longer for non-Hispanic black and Hispanic children than for non-Hispanic white children. Children in EDs with higher shares of non-Hispanic black and Hispanic children waited longer. Moreover, Hispanic children waited 10.4 percent longer than non-Hispanic white children when treated at the same hospital. ED wait times for children did not vary significantly by payment source.

CONCLUSIONS

There are sizable racial/ethnic differences in children's ED wait times that can be attributed to both the racial/ethnic mix of children in EDs and to differential treatment by race/ethnicity inside the ED.