Authors: Yosef A. Albahrani , Zahrah Alkashi , Sarah Alhammad , Maitham Aljubran

Abstract

Background: The growing utilization of pediatric urgent care (UC) centers as alternatives to emergency departments (EDs) for low-acuity conditions has significant implications for healthcare costs, wait times, and clinical outcomes. However, concerns persist regarding diagnostic accuracy, appropriateness of care, and disparities in access.
Methods: This systematic review, conducted following PRISMA guidelines, analyzed 13 studies comparing pediatric UC and ED settings. Databases (PubMed, Web of Science, Scopus, Embase, Cochrane) were searched with date restriction to the last 10 years (2015-2025), without language restrictions. Outcomes assessed included cost efficiency, wait times, and clinical outcomes (admission rates, diagnostic accuracy, and patient safety). Risk of bias was evaluated using the Newcastle-Ottawa Scale.
Result: In this systematic review, UC visits were significantly less expensive than ED visits (median cost: $76.90 vs. $186.20), with comparable admission rates (<1%). Wait times were shorter in UC (median 1.2 vs. 3.5 hours in EDs). However, 27% to 85% of UC-to-ED transfers were deemed unnecessary, often due to diagnostic uncertainty or limited pediatric readiness. Quality improvement interventions, such as antibiotic stewardship programs, improved guideline adherence (28%-64%). Malpractice claims revealed diagnostic errors as a major concern (41% of cases), particularly for appendicitis and respiratory conditions.
Conclusion: Based on the results of this study, Pediatric UC centers reduce costs and ED overcrowding while maintaining care quality for low-acuity conditions. However, high rates of avoidable transfers and diagnostic challenges highlight the need for enhanced pediatric training, standardized triage protocols, and telemedicine support. Policymakers should prioritize interventions to optimize UC utilization while ensuring equitable access and patient safety.

Keywords: Pediatric urgent care, Emergency departments, Healthcare costs, Wait times, Clinical outcomes, Diagnostic accuracy, Healthcare disparities.