428 Pediatric Visits to United States Emergency Departments for Alcohol-Related Disorders

Abstract

To determine the number of pediatric patients (age ≤ 17) presenting to emergency departments (EDs) in the United States from 2006-2007 for alcohol-related disorders and examine selected clinical and demographic features of this population. This was a retrospective cohort study using 2 years (2006-2007) of data from the Nationwide Emergency Department Sample (NEDS). The NEDS is a stratified, multi-stage sample designed to provide national estimates of ED visits in the US. It is the largest all-payer ED database in the US and contains over 25 million records for ED visits each year. Clinical Classifications Software (CCS) was used to identify patients under 18 with an alcohol-related ED visit. Cases were selected if a CCS = 660 (“alcohol-related disorders”) was present in any of the CCS discharge diagnoses. The following clinical and demographic features were examined in this population: number of admissions, teaching status of hospital, disposition, expected payer, income, sex, geographic region of hospital and primary diagnoses, SAS-Callable SUDAAN software was used to produce unbiased standard errors. From 2006-2007, 144,619 pediatric patients presented to US EDs and received a subsequent diagnosis of an alcohol-related disorder. The mean age of the sample was 15.61 years (95% CI 15.57-15.65). Over half (55.07%) of these patients were seen in teaching hospitals with 14.53% requiring admission to the hospital. Most patients had private insurance (52.21%) and were significantly more likely to reside in communities with the highest median income quartile (≥ $63,000; 29.27%; 26.61-32.08) compared to the lowest (≤ 38,999; 21.33%; 19.18-23.66). These patients were also significantly more likely to be male (54.28%; 53.55-55.23 versus 45.69%; 44.75-46.64, female) and present to EDs in the Western geographic region of the US (31.21%; 28.40-34.15 versus 22.35%, Northeast, 24.27%, Midwest, and 22.18%, South). The total charges for patients who were treated in the ED and released was $164,832,551.46 and the total charges for those admitted was $372,237,546.24. CCS 660 (alcohol-related disorders) was the primary diagnosis for most of the sample (60.56%). Other common primary diagnoses included the following: mood disorders, substance-related disorders, superficial injury and contusion, medical examination/evaluation, other injuries and conditions due to external causes, open wounds of head, neck, and trunk, poisoning by other medications and drugs, open wounds of extremities, and intracranial injury. There were over 140,000 estimated visits to US EDs by patients under 18 for alcohol-related disorders, accounting for over half a billion dollars in charges. The majority of these patients were male and were from higher income communities. Less than 15% were admitted to the hospital. Other common diagnoses were related to injuries and psychiatric/substance-related disorders. Most patients presented with a primary diagnosis related to alcohol as opposed to injuries or other diagnoses.