Children with chronic conditions in a paediatric emergency department

Aim: To describe the use of a paediatric emergency department by children with chronic conditions. Material and methods: We prospectively indexed all the children seen in our emergency department during 1 y to describe the population of children with chronic conditions, and to compare it with the general paediatric population. Results: There were 11 483 patient visits, of which 11% were by chronically ill children. Six subspeciality areas accounted for the vast majority of the chronic conditions seen: neurology (30%), cardiology (18%), pulmonology (18%), nephro-urology (16%), haemato-oncology (9%) and endocrinology (4%). Admission rate to the hospital was significantly higher for chronically ill patients (38% vs 23%). Among chief complaints, fever, respiratory distress, headache and seizures were overrepresented in chronically ill children. The chief complaint was related to the child's chronic condition in 51% of the visits. In both chronically and non-chronically ill patients, the majority of final diagnoses were related to infection (57% and 65%, respectively). Among diagnoses, bacterial infections, seizures, vasovagal syncopes and asthma were overrepresented in chronically ill children. Conclusion: From the analysis of our data, we conclude that children with chronic conditions account for a tenth of all visits to a paediatric emergency department. The paediatric emergency physicians provide an important service to both the children with chronic conditions and the subspecialists who care for them.