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Objective: To characterise ED presentations among youth in New South Wales (NSW) by geographic remoteness for 2019 and determine if intra‐regional (inland vs coastal) variations exist. Methods: A population‐based, retrospective descriptive analysis of 2019 Emergency Department Data Collection registry data for state‐wide emergency presentations to NSW public hospitals among NSW residents aged 10–24 years was undertaken. Local government areas of residence were classified as major city, coastal regional, inland regional or remote. Sex and age‐adjusted ED presentation rates were modelled according to geographical classification, using negative binomial regression. Results: In 2019, 178 public ED facilities in NSW received 479 880 presentations from NSW residents aged 10–24 years. ED presentation rates in regional and remote areas were more than twice (incidence rate ratio 2.23, 95% confidence interval 2.08–2.39) and four times (incidence rate ratio 4.32, 95% confidence interval 3.84–4.87) that, respectively, of major cities. Compared to major cities, youth presenting to regional and remote facilities spent 36% and 60% less time in ED, respectively, with presentations less likely to be deemed critical, occur after‐hours or result in hospital admission. Variation between inland and coastal regional indicators was minimal. Conclusions: Patterns of ED utilisation between major city, regional and remote youth were distinctly different, but not so between coastal and inland regional youth. Further research could better understand ED utilisation among youth and the drivers of higher presentation rates in regional and remote areas. [ABSTRACT FROM AUTHOR]