Evaluation of pediatric patients referred from the secondary care state hospital emergency department

Aims: Determining the profiles of pediatric patients who need to be referred from the emergency department is important in terms of taking the necessary precautions during the referral process and providing care opportunities. This study aimed to examine the characteristics of pediatric patients who applied to our hospital's emergency department and were referred to other hospitals. Methods: A total of 4870 pediatric patients between the ages of 0-17 who were admitted to the emergency department of our secondary care district hospital or were referred to other hospitals, were included in the study. Results: The median age of the patients was 7 (min-max 0-17) years, and 2809 (57.7%) were male. The highest referral rate during the day was between the hours of 16-24 (46.6%). A total of 66.5% of referrals were made to tertiary care hospitals, and 92.8% were to the emergency department. The most common cause for referral was the lack of relevant branch and/or specialist (68.8%). The most common preliminary diagnosis or findings in referred children were convulsion (11.4%), acute appendicitis (9.0%) and abdominal pain (6.2%). In the 14-17 age group, the rate of those referred due to convulsions, trauma, burns and ileus was significantly lower than the other groups, while the rate of those referred due to drug poisoning, traffic accident, chest pain, pneumothorax, sharp object injuries and electric shock was significantly higher (p<0.05). The rate of those referred due to fever, chemical exposure, ileus, foreign body aspiration or ingestion, respiratory failure, acute gastroenteritis and gastrointestinal hemorrhage was significantly higher in the 0-3 age group compared to other groups (p<0.05). In cases such as drug poisoning, soft tissue injury, fall, fever, trauma, traffic accident, burn, foreign body aspiration or ingestion, pneumothorax, fracture and head trauma, the rates of patients referred to the tertiary care were significantly higher than those referred to the secondary care (p<0.05). Conclusion: The findings obtained from this study has showed that the most frequently referred cases in pediatric patients are acute appendicitis, convulsion and abdominal pain, that the majority of referrals are made to tertiary care hospitals and especially emergency services, that the absence of a relevant branch or specialist physician is the most common reason for referrals, that the patients' preliminary diagnoses, patient age and time of admission significantly direct the referral characteristics.