Rising paediatric emergency department use despite demographic decline: a 23-year analysis

BACKGROUND: Over the past two decades, paediatric emergency departments (PEDs) worldwide have experienced an increase in attendance, despite declining birth rates and enhanced access to primary care. This paradox suggests that the rising demand may be attributed to non-urgent conditions rather than genuine paediatric emergencies. Understanding the impact of demographic decline on PED utilisation is essential for effective health-service planning. This study assessed long-term trends in PED utilisation and hospitalisations in relation to declining birth rates in Liguria, Italy. METHODS: A retrospective time-series analysis of PED visits and hospitalisations at Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Giannina Gaslini Children's Hospital from 2002 to 2024 was conducted. Data on annual live births and residents aged ≤14 years were obtained from regional datasets. The incidence rates of PED visits and hospitalisations were calculated relative to births and the paediatric population. Trends were analysed using correlation coefficients, with sensitivity analyses excluding the COVID-19 years (2020-2021). RESULTS: Over 23 years, 840 221 PED visits and 85 186 hospitalisations were recorded. Hospitalisations per 1000 PED visits decreased significantly (p