Beyond clinical urgency: parental awareness, educational level, and non-urgent pediatric emergency department utilization

Abstract

Objective Non-urgent visits to pediatric emergency departments (PEDs) constitute a persistent global problem that strains healthcare resources and may compromise care quality for critically ill patients. This study aimed to examine the socio-educational determinants of parental responsiveness to emergency-use informational messaging and to characterize the healthcare-seeking behaviors underlying low-acuity PED utilization at a tertiary-level center with an annual pediatric caseload of approximately 120,000 visits.Materials and Methods In this prospective cross-sectional study, data were collected from parents via structured questionnaires administered during triage. Children triaged into the high-acuity Red or Orange Manchester Triage System (MTS) categories were excluded a priori, while Green and Blue categories were combined into a single lower-acuity group based on their comparable clinical management pathways. Multivariable logistic regression was used to identify independent predictors of an affirmative parental response to informational messaging on appropriate emergency department use.Results A total of 453 parents were included in the study. Participants were predominantly female (68.2%), with a median parental age of 36.0 years, and 64.2% of visits were classified into the lower-acuity (Green/Blue) group. Agreement between parental urgency perception and MTS triage category was minimal (Cohen's kappa=0.040, 95% CI -0.035 to 0.116; PABAK=-0.051), with no significant association between subjective urgency perception and objective triage classification (p = 0.298). Parental educational level was the strongest independent predictor of affirmative responsiveness to informational messaging, with each one-level increase associated with 1.45-fold higher odds (adjusted OR = 1.45; 95% CI: 1.14-1.86; p = 0.003). Across triage categories, the expectation of faster medical evaluation was the leading motivation for PED attendance (36.1%). Among lower-acuity presentations, 38.1% required laboratory or radiological investigations and 7.9% resulted in observation or inpatient admission, compared with 53.0% and 24.7%, respectively, for the whole cohort. When offered the alternative of after-hours outpatient services, 53.4% of parents indicated they would use them.Conclusions These findings suggest that PED overcrowding is driven not solely by parental knowledge deficits but also by systemic barriers in primary care accessibility and parents' low risk tolerance. Effective interventions should therefore extend beyond public health education to restructure after-hours primary care as a credible and accessible alternative to emergency services.