(255) The association between chronic pain and emergency department use among children with special health care needs

Abstract

Pediatric chronic pain is costly to society. Rate of emergency department (ED) visits is particularly important to understand because ED visits account for a sizable proportion of the total financial burden. However, among youth with health conditions, little is known about the effect of chronic pain on ED use. The aim of this study was to examine the association between chronic pain and ED use in a large sample of children with special health care needs. Data were collected through the 2009-2010 National Survey of Children with Special Health Care Needs (CSHCN), a nationally representative survey conducted by the National Center for Health Statistics. The sample includes 40,242 youth aged 0-17 years (Mage=10.2) identified as having special health care needs related to physical, emotional, and behavioral disorders. Nationwide, 29% of CSHCN were reported to have “a little” or “a lot” of difficulty with chronic pain. Of these, 47% were female, average age was 11.7 years, and 57% were non-Hispanic White. Children with chronic pain used ED services twice as frequently as those without chronic pain (M=1.4 and .77, annual visits respectively). We applied a zero-inflated negative binomial regression model to examine the association between chronic pain and ED visits. Expected rate of ED visits within the past 12 months was 52% higher for CSHCN with chronic pain compared to CSHCN without chronic pain (IRR=1.52, 95% CI=1.38-1.69), while controlling for age, sex, race, poverty level, parental education, insurance status, number of comorbid conditions and functional disabilities. Having chronic pain significantly elevates risk for having an ED visit and the expected rate of ED service utilization among CSHCN. Comprehensive management approaches that specifically address chronic pain may be essential for limiting high-cost services and for better utilizing health resources for youth with a range of special health needs. Pediatric chronic pain is costly to society. Rate of emergency department (ED) visits is particularly important to understand because ED visits account for a sizable proportion of the total financial burden. However, among youth with health conditions, little is known about the effect of chronic pain on ED use. The aim of this study was to examine the association between chronic pain and ED use in a large sample of children with special health care needs. Data were collected through the 2009-2010 National Survey of Children with Special Health Care Needs (CSHCN), a nationally representative survey conducted by the National Center for Health Statistics. The sample includes 40,242 youth aged 0-17 years (Mage=10.2) identified as having special health care needs related to physical, emotional, and behavioral disorders. Nationwide, 29% of CSHCN were reported to have “a little” or “a lot” of difficulty with chronic pain. Of these, 47% were female, average age was 11.7 years, and 57% were non-Hispanic White. Children with chronic pain used ED services twice as frequently as those without chronic pain (M=1.4 and .77, annual visits respectively). We applied a zero-inflated negative binomial regression model to examine the association between chronic pain and ED visits. Expected rate of ED visits within the past 12 months was 52% higher for CSHCN with chronic pain compared to CSHCN without chronic pain (IRR=1.52, 95% CI=1.38-1.69), while controlling for age, sex, race, poverty level, parental education, insurance status, number of comorbid conditions and functional disabilities. Having chronic pain significantly elevates risk for having an ED visit and the expected rate of ED service utilization among CSHCN. Comprehensive management approaches that specifically address chronic pain may be essential for limiting high-cost services and for better utilizing health resources for youth with a range of special health needs.