Abstract 9440: Incidence, Charge, and Outcomes of Emergency Department Visits for Children with Single Ventricle Congenital Heart Disease from 2006-2018

Abstract

Introduction: Children with single ventricle (SV) congenital heart disease have high morbidity, mortality and resource utilization when admitted to the hospital but few data exist on emergency department (ED) visits. Understanding patterns in ED encounters among children with SV may target interventions to improve outcomes. We described a national sample of SV ED visits and evaluated patient characteristics, encounters, and trends in admissions, charge, and mortality. Methods: This retrospective cohort study evaluates ED encounter level data from the 2006-2018 Nationwide Emergency Department Sample. Patients < 18y with SV were identified using ICD-9/10 codes. Results: From 2006-2018, 52,512 SV ED visits were identified. Most SV ED encounters were male (61%) and < 4y (65%). Patients with > 1 complex chronic condition (CCC) comprised nearly 1/3 encounters (32%). Half of encounters (49%) resulted in admission or transfer, and the median inflation-adjusted charge per ED encounter was $1,939 (IQR $1,098-3,217). Nearly 1 in 50 SV ED visits resulted in death, in the ED or during the associated admission. Independent predictors of admission included age <1y [OR 2.60 (2.12, 3.19)], presenting to a metropolitan teaching hospital [OR 6.31 (4.53, 8.80)], presenting with HF [OR 7.70 (5.33, 11.12)], arrythmia [OR 2.81 (1.89, 4.18)], respiratory disease [OR 5.13 (4.13, 6.43)], or sepsis [OR 8.64 (4.09, 18.26)], and the presence of 1 [OR 2.15 (1.90, 2.42)] or > 2 CCC’s [OR 6.89 (5.56, 8.53)]. Independent predictors of mortality included age <1y [OR 8.55 (3.28, 22.32)], presenting with HF [OR 4.97 (2.99, 8.27)], and > 2 CCC’s [OR 2.19 (1.43, 3.36)]. Annual SV visits increased from 3,082 to 5,483 ( p for trend=0.003) and the inflation-adjusted charge per ED encounter increased by 50%, from $1,760 to $2,612 ( p for trend=0.002). There was no identified change in mortality ( p for trend=0.08). Conclusions: Half of ED visits of children with SV result in admission/transfer and 2% result in death. While the incidence and charges of SV ED visits increased over the years studied, there was no identified change in mortality. The high admission/transfer rate for children with SV presenting to the ED reflect a high-risk population; further attention must be given to improving their outcomes.