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Original article
Emergency department use by paediatric patients in Lombardy Region, Italy: a population study
  1. Benedetta Riva1,2,
  2. Antonio Clavenna1,
  3. Massimo Cartabia1,
  4. Angela Bortolotti3,
  5. Ida Fortino3,
  6. Luca Merlino3,
  7. Andrea Biondi2,
  8. Maurizio Bonati1
  1. 1 Department of Public Health, Laboratory for Mother and Child Health, IRCCS Istituto di Ricerche Farmacologiche ‘Mario Negri’, Milan, Italy
  2. 2 Department of Pediatrics, Hospital S. Gerardo/Fondazione MBBM, University of Milano-Bicocca, Monza, Italy
  3. 3 Regional Health Ministry, Lombardy Region, Milan, Italy
  1. Correspondence to Dr Antonio Clavenna; antonio.clavenna{at}


Objectives To estimate the rate of paediatric attendance at emergency departments (EDs) in the Lombardy Region, Italy, and to determine the factors contributing to different patterns of use.

Methods By analysing healthcare administrative databases, ED attendance by 1.6 million youths <18 years old during 2012 in the Lombardy Region was assessed. The pattern of use was categorised based on the number of ED visits and level of emergency, defined by triage code and outcome of the visit. Logistic regression analyses were performed to identify the characteristics of access for non-urgent reasons and those of patients with frequent non-urgent access (≥4 accesses for non-urgent reasons only). A case–control study was carried out to compare healthcare resource use by children 1–5 years old who were ‘frequent non-urgent users’ with that of randomly selected controls, matched by age, gender, nationality and primary care physician.

Results During 2012, 440 284 (27%) of children and adolescents had at least one ED attendance, with trauma (26%) and respiratory tract infections (22%) as the most frequent diagnoses. In all, 533 037 (79%) accesses were for non-urgent reasons, and 12 533 (3% of the ED users) were frequent non-urgent users. Male gender (OR 1.12; 95% CI 1.08 to 1.17), preschool age (OR 3.14; 95% CI 2.98 to 3.31) and place of residence (OR 1.74; 95% CI 1.70 to 1.99) were associated with a higher risk of being a frequent non-urgent user. Moreover, a greater healthcare consumption was observed in this group.

Conclusions One out of four children and adolescents attended the ED at least once per year, 3% of whom were frequent non-urgent users, with a high overall healthcare resource consumption.

  • epidemiology

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  • Contributors All the authors contributed equally to the design of the study. BR was involved in planning the data analysis and wrote the first draft of the manuscript. AC contributed in planning the data analysis and in writing the manuscript. MC undertook the statistical analysis. AngB, IF and LM were involved in data collection and management. AC, AndB and MB supervised the study. All authors contributed to and have approved the final manuscript.

  • Funding The study was funded by the Lombardy Region (EPIFARM Project).

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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