Epidemiology and clinical manifestations of individuals presenting to St Vincent's Emergency Department from Victorian correctional facilities: an observational study

Introduction: The incarcerated population in Australia has grown substantially, with individuals in prison experiencing complex health needs and barriers to accessing timely healthcare. Despite these challenges, there is limited data on the reasons incarcerated individuals present to EDs. This study aims to describe the characteristics, clinical presentations and outcomes of correctional patients presenting to a tertiary ED. Methods: This retrospective study included individuals flagged as incarcerated in the hospital's electronic medical records who presented to St Vincent's Emergency Department (Victoria, Australia) between 1 January 2014 and 31 December 2023 and a case series of ICU-admitted incarcerated individuals. Results: A total of 10,682 ED presentations were recorded from 5890 unique incarcerated individuals. Their median age was 35 years (interquartile range = 17). Most were male (85.1%), most were non-Indigenous (79.2%), with 9.2% identifying as First Nations people. The proportion of correctional patients who identified as First Nations people increased from 5.1% in 2014 to 13.6% in 2023, indicating an average annual increase of approximately 17%. Female First Nations people were disproportionally represented in this study compared to their non-Indigenous counterparts (20.0% vs. 14.9%, p = 0.002). Forty-four presentations from correctional centres were admitted to the intensive care unit (ICU). Most presentations to the ED were discharged to correctional facilities (72.9%). Conclusion: Incarcerated individuals present to EDs with acute health needs. First Nations people are disproportionately represented and require culturally safe, gender-responsive care. These findings highlight the need to improve equitable access to high-quality emergency care and patient-centred prison health services.