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Abstract

Introduction: The AAP/Bright Futures guidelines recommend screening for substance use in adolescents. Substance use in children has been associated with negative societal outcomes: poor school performance, high risk behaviors and increased risk of unintentional injuries. Current estimates and outcomes associated with substance use in children needing emergency department(ED) visits are unclear. Methods: The Nationwide Emergency Department Sample of the Healthcare Cost and Utilization Project sponsored by the Agency for Healthcare Research and Quality for year 2009 was used. A retrospective analysis of all ED visits with substance related disorders among those aged ≤ 21 years was performed. Demographic characteristics of patients were examined. Outcomes examined included disposition following ED visit, ED charges, and hospitalization charges. Descriptive analyses were used. Results: During the year 2009, a total of 287,285 ED visits were attributed to substance related disorders among those aged ≤ 21 years. Of these, close to 32% occurred among those aged ≤ 17 years. Close to 60% were males. Following an ED visit, 61% were discharged routinely while 29% were admitted as inpatients into the same hospital. A total of 96 children died in the ED and 216 died following admission into the same hospital as inpatients. The major payers were Medicaid (32.3% of all ED visits) and private insurance plans (36%). Close to 25.9% of all ED visits occurred among the uninsured. About 55% of all ED visits occurred among those residing in areas with annual household income levels <$50,000. The mean charge per ED visit was $2,162. The total ED charges across the entire United States was $493.59 million. The mean hospitalization charge following admission as an inpatient was $21,445. The total hospitalization charges across the entire United States was $1.768 billion. Conclusions: Males and those residing in low income households are amongst the high risk groups seeking ED care due to substance related disorders. A significant amount of healthcare resources are used in hospital based settings for treating substance related disorders among children in the United States.