An underrecognized population in pediatric emergency care: process challenges for children deprived of liberty

PURPOSE: Children deprived of their liberty represent a vulnerable and underrecognized population in pediatric emergency departments. This study aims to describe the clinical and process-related characteristics of these encounters, identify factors associated with emergency department length of stay (ED-LOS) and evaluate changes observed after workflow interventions. DESIGN/METHODOLOGY/APPROACH: This retrospective study included a process-oriented pre-post evaluation in a tertiary pediatric emergency department. Children deprived of their liberty presenting during the study period were included. The primary outcome was ED-LOS. Prolonged ED-LOS was defined as a stay exceeding 8 h. Secondary outcomes included diagnostic testing, imaging, consultations, hospitalization, repeat visits, reasons for presentation and consent-related workflow barriers. FINDINGS: A total of 114 encounters were evaluated. The mean age was 16.04 ± 1.08 years, and 86.0% were male. Foreign body ingestion and trauma were the most common reasons for presentation. ED-LOS exceeded 8 h in 14.9% of encounters. Laboratory testing, imaging, consultations and consent-related workflow barriers were associated with ED-LOS, whereas presentation time and weekday versus weekend arrival were not. The proportion of encounters exceeding 8 h decreased from 20.3% to 6.7% after the interventions (p = 0.046). Hospitalization rates increased. ORIGINALITY/VALUE: To the best of the authors' knowledge, this study is among the first process-oriented evaluations of pediatric emergency care for children deprived of their liberty in Türkiye. The findings suggest that prolonged ED-LOS may be more closely related to diagnostic processes, consultations, consent and disposition workflows than to temporal characteristics of presentation. Workflow interventions may contribute to reducing prolonged emergency department stays.