Abstract
BackgroundChildhood injuries are increasingly treated in emergency departments (EDs) but the relationship between injury severity and ED resource utilization has not been evaluated. The objective of this study was to compare resource utilization for pediatric injury-related ED visits across injury-severity levels and with non-injury visits, using standardized, validated scales.MethodsA retrospective analysis of 2004-2008 ED visits from the Pediatric Emergency Care Applied Research Network Core Data Project. Maximum Abbreviated Injury Scale severity (MAIS) and Severity Classification System (SCS) scores were calculated and compared. MAIS and SCS are ordinal scales from 1 (minor injury) to 6, and 1 (low anticipated resource utilization) to 5, respectively. ED length of stay (LOS) and admission percentages were calculated as comparative proxy measures of resource utilization.ResultsThere were 763,733 injury visits and 2,328,916 non-injury visits, most with SCS of 2 or 3. Of the injured patients, 59.2 % had an MAIS of 1. ED LOS and admission percentage increased with increasing MAIS from 1-5. LOS and admission percentage increased with increasing SCS in both samples. Median LOS was shorter for injured versus non-injured patients with SCS 3-5. Non-injured patients with SCS 2-5 were more likely admitted than injured patients. Most injured patients had an SCS 3 with an MAIS 1-2, or an SCS 2 with an MAIS 1, with no correlation between the two scales.ConclusionWhile admission rates and LOS increase with increasing AIS and SCS severity, these two classification schemas do not reliably correlate. Similarly, ED visit metrics differ between injured and non-injured patients in similar SCS categories. Although AIS and SCS both have value, these differences should be considered when using these schemas in research and quality improvement.
Highlights
Childhood injuries are increasingly treated in emergency departments (EDs) but the relationship between injury severity and ED resource utilization has not been evaluated
Abbreviated Injury Scale (AIS) and Severity Classification System (SCS) both have value, these differences should be considered when using these schemas in research and quality improvement
We recently described pediatric injury-related ED visits over 5 years from 2004-2008, including individualand community-level socio-demographic characteristics, and found an increase in ED visits over the study period but with a stable degree of injury severity. (Macy et al 2015)
Summary
Childhood injuries are increasingly treated in emergency departments (EDs) but the relationship between injury severity and ED resource utilization has not been evaluated. The objective of this study was to compare resource utilization for pediatric injury-related ED visits across injury-severity levels and with non-injury visits, using standardized, validated scales. We have evidence of increasing numbers of ED visits by children with low to moderate injury severity, the relationship between measures of injury severity and resource utilization for ED visits by children has had limited exploration. This is important since understanding patterns of anticipated resource needs could have implications for triaging and cohorting of patients in the ED setting. The goals of this study were to 1) compare resource utilization for pediatric injury-related ED visits versus non-injury visits and 2) compare resource utilization across levels of injury severity using standardized, validated scales
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