Measures to discourage parents from self-referrals to the ED may delay diagnosis and treatment of serious illness, according to study results published online.
Yvette van Ierland, MD, MSc, and colleagues of the department of general pediatrics at Erasmus MC/Sophia Children’s Hospital in Rotterdam, Netherlands, performed a cross-observational study of EDs of a university and a teaching hospital that was composed of either self-referred or general practitioner-referred children aged younger than 16 years from 2006 to 2008. Of the 4,609 children in the study sample, 38% were referred by a general practitioner and 62% were self-referred.
There was little difference in the percentage of high urgency cases: 46% of general practitioner-referred patients vs. 45% of self-referrals, according to researchers.
The researchers said children with fever who were self-referred to EDs were less ill than those referred by a physician; but overall, many parents were accurate at assessing their children’s need for emergency care. Before this study, self-referrals to EDs have been discouraged because it was thought that, similar to adult self-referrals, many pediatric referrals to EDs would be unnecessary. This study has found this not to be the case, and researchers recommend that physicians do not discourage parents from self-referral to EDs if their child seems seriously ill.
“Self-referred children with fever must not be generalized and approached as a uniform group of nonseverely ill patients. General measures to discourage self-referrals from presenting to the (community) ED are undesirable for children with fever; this action may result in delayed or missed diagnoses and potentially increase morbidity and mortality.”
Disclosure: The researchers report no relevant financial disclosures.