TOPLINE:

Children and young individuals (age ≤ 15 years) who remained high-frequency emergency department (ED) attenders across 2 years were often from the most deprived areas; infants younger than 1 year showed greater heterogeneity in reasons for ED attendances than older children.

METHODOLOGY:

• Researchers conducted a population-based retrospective cohort study to examine ED attendance patterns over 2 years among children and young individuals (age ≤ 15 years) and to assess heterogeneity in reasons for ED use among high-frequency attenders.
• They used routinely collected data from EDs in the UK and included 71,143 children and young individuals with at least one ED attendance, and each was followed up for two consecutive 12-month periods from their first recorded ED attendance between March 2014 and April 2015.
• High-frequency attenders were defined as individuals with at least three attendances in a 12-month period.
• Heterogeneity in reasons for attendances was assessed using the Herfindahl index among those with at least seven attendances over 2 years; the score ranged from 0 to 1, with the value close to 1 indicating lower heterogeneity and the value close to 0 indicating higher heterogeneity.
• Primary reasons for attendance were grouped as injury-related or illness-related attendance using standardised diagnostic codes across EDs.

TAKEAWAY:

• Among 9700 (13.6% of the cohort) high-frequency ED attenders in year 1, 5345 (55.1%) made at least one ED attendance in year 2 and 1369 (14.1%) remained high-frequency attenders across both years.
• Individuals who were high-frequency attenders across both years were more likely to come from more deprived Index of Multiple Deprivation categories than those who had only one attendance over 2 years (73.6% vs 62.7%).
• Injury‑related attendances were less prevalent among high‑frequency attenders than among single attenders in both years (35.0% vs 47.2%); conversely, illness‑related attendances were more common among high‑frequency vs single attenders (31.5% vs 19.4%).
• Young individuals aged 8-12 years showed lower heterogeneity (higher Herfindahl index scores) in reasons for attendance, with a higher proportion of injury-related visits; however, infants younger than 1 year exhibited higher heterogeneity (lower Herfindahl index scores), with illness-related ED visits being more frequent.

IN PRACTICE:

"This study highlights the need for targeted interventions to address persistent high-frequency ED use among C&YP [children and young people], particularly those from more deprived backgrounds," the authors wrote.

"It also introduces a method for quantifying heterogeneity in reasons for attendance, revealing important age-related patterns. These findings can inform future research and service planning aimed at improving care for high-frequency ED users among C&YP," they concluded.

SOURCE:

This study was led by Akshay Kumar, University of Leeds, Leeds, England. It was published online on February 26, 2026, in BMJ Paediatrics Open.

LIMITATIONS:

Inconsistency in primary diagnosis coding across EDs and time periods may have introduced classification bias, and potential selection bias was caused by the exclusion of hospitals with incomplete diagnostic information. Additionally, the use of pre‑COVID data limited generalisability.

DISCLOSURES:

This study was funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Yorkshire and Humber at the University of Sheffield and was also supported by the NIHR Applied Research Collaboration South West Peninsula. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.