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Pediatric Referrals to an Emergency Department From Urgent Care Centers

Olympia, Robert P., MD*; Wilkinson, Robert, DO; Dunnick, Jennifer, MD; Dougherty, Brendan J., RN*; Zauner, Debra, MD§

doi: 10.1097/PEC.0000000000000955
Original Articles
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Objective The aims of this study were to describe pediatric emergency department (ED) referrals from urgent care centers and to determine the percentage of referrals considered essential and serious.

Methods A prospective study was conducted between April 2013 and April 2015 on patients younger than 21 years referred directly to an ED in central Pennsylvania from surrounding urgent care centers. Referrals were considered essential or serious based on investigations/procedures performed or medications/consultations received in the ED.

Results Analysis was performed on 455 patient encounters (mean age, 8.7 y), with 347 (76%) considered essential and 40 (9%) considered serious. The most common chief complaints were abdominal pain (83 encounters), extremity injury (76), fever (39), cough/cold (29), and head/neck injury (29). Thirty-three percent of the patients received laboratory diagnostic investigations (74% serum, 56% urine), and 52% received radiologic investigations (67% x-ray, 17% computed tomography scan, 13% ultrasound, 11% magnetic resonance imaging). Forty-four percent of the patients received a procedure, with the most common being intravenous (IV) placement (66%); reduction, casting, or splinting of extremity fracture/dislocation (18%); and laceration repair (14%). The most common medications administered were IV fluids (33%), oral analgesics (30%), and IV analgesics (26%). Eighty-three percent of the patients were discharged home, 12% were hospitalized, and 4% had emergent surgical intervention. The most common primary diagnoses were closed extremity fracture (60 encounters), gastroenteritis (42), brain concussion (28), upper respiratory infection (24), and nonsurgical, unspecified abdominal pain (24).

Conclusions Many ED referrals directed from urgent care centers in our sample were considered essential, and few were considered serious. Urgent care centers should develop educational and preparedness strategies based on the epidemiology of emergencies that may occur.

From the *Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA;

Department of Emergency Medicine, University of New Mexico, Albuquerque, NM;

Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT; and

§Department of Pediatrics, Penn State Children's Hospital, Hershey, PA.

Disclosure: The authors declare no conflict of interest.

Reprints: Robert P. Olympia, MD, Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, 500 University Dr, PO Box 850, Hershey, PA 17033-0850 (e-mail: rolympia@hmc.psu.edu).

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