Abstract
There are minimal data on emergency department (ED) resource utilization for pediatric patients with ventricular assist devices (VADs), and it is unclear if adult data can be extrapolated to children. This analysis of national estimates of ED-visit level encounters uses the Nationwide Emergency Department Sample (NEDS). Patients from 2006 to 2014 with VADs were identified using ICD-9 codes and categorized as pediatric (≤18y), young adult (19-44y), middle adult (45-64y) and older adult (≥65y). The primary outcome was death; secondary outcomes included median inflation adjusted charge, admission/transfer rate, and primary encounter diagnoses. Over the 9 years studied, a total of 254 (95% CI 190-318) pediatric, 3,003 (95% CI 2424-3582) young adult, 7,590 (95% CI 6220-8961) middle adult, and 6,857 (95% CI 5604-8110) older adult ED encounters were identified. Compared to all other age groups, the pediatric VAD ED encounters were more likely to occur at a non-teaching or non-metropolitan ED, to have private insurance as a primary payer, and have a higher proportion of female patients (p ≤ 0.0003 for all). The two most frequent primary encounter diagnoses in pediatric patients were acute gastrointestinal (19%) and respiratory complaints (14%), both of which were uncommon in all adult age groups (p < 0.0001). Admission/transfer rate and charges were significantly lower for pediatric VAD ED encounters (p < 0.0001 for both, Figure). In contrast, overall inpatient and ED mortality did not differ (1.7% vs. 2.3% to 5.3%, p > 0.2 for all). In this study evaluating ED resource utilization of VAD patients, pediatric patients had much lower admission rate and charges compared to their adult counterparts-likely reflecting generally lower acuity complaints or potentially less medical complexity. Still, high mortality rates across all ages highlights the ubiquitous fragility of patients with VADs presenting to the ED and the need for strategies to reduce morbidity and mortality.
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