PEDIATRIC CONSULTATION PATTERNS IN GENERAL-PRACTICE AND THE ACCIDENT AND EMERGENCY DEPARTMENT

The age, sex, source of referral and diagnosis of children brought to a paediatric accident and emergency department by their parents were c ompared to those consulting their general practitioner, A simultaneous , prospective review of these consultations was carried out over a six -week period in an inner-city paediatric teaching hospital and a group practice in a socially deprived urban area. 730 children less than 13 years of age who presented for a new consultation were seen. 629 (86% ) presented initially to the general practitioner, who dealt with all but 25 (4.0%) without onward referral to the accident and emergency de partment. 127 consultations took place at the accident and emergency d epartment, of which 104 (82%) were parental referrals. There was no se x difference in children seen by the general practitioner. There was a decreasing trend with increasing age in the proportion of children wh o consulted the general practitioner, perhaps due to the higher freque ncy of injury in the older children. Over three quarters (77%) of inju red children were brought directly to the accident and emergency depar tment, compared with only 4% of children without injuries (p<0.0001). Of 22 children with injuries who presented to the general practitioner , only 4 (18%) required onward referral. General practitioners met the great majority of the paediatric workload generated by the practice. Audit between primary and secondary care gives a more reliable picture than data from only one source. Injured children are more likely to b e taken to the accident and emergency department. Further study of the severity of injury in children is required to determine if there is p otential to reduce parental referrals to accident and emergency depart ments.