Abstract
IntroductionEpidemiological surveillance data for emergency department (ED) visits by children are imperative to guide resource allocation and to develop health policies that advance pediatric emergency care. However, there are sparse population-based data on patient-level information (e.g., the number of children who present to the emergency department [ED]). In this context, we aimed to investigate both the patient- and visit-level rates of ED utilization by children.MethodsThis was a retrospective cohort study using population-based multipayer data – state ED databases (SEDD) and state inpatient databases (SID) – from six geographically-dispersed U.S. states (California, Florida, Iowa, Nebraska, New York, and Utah) in 2010 and 2011. We identified all children aged <18 years who presented to the ED and described the patient-level ED visit rate, visit-level ED visit rate, and proportion of all ED visits made by children. We conducted the analysis using the 2011 SEDD and SID data. We also repeated the analysis using the 2010 data to determine the consistency of the results across different years.ResultsIn 2011, 2.9 million children with a patient identifier presented to EDs in the six U.S. states. At the patient-level, 15 out of every 100 children presented to an ED at least once per year. Of these children, 25% presented to EDs 2–3 times per year with an approximately 1.5-fold variation across the states (e.g., 19% in Utah vs. 28% in Florida). In addition, 5% presented to EDs ≥4 times per year. At the visit-level, 6.7 million ED visits were made by children in 2011 – 34 ED visits per 100 children annually. ED visits by children accounted for 22% of all ED visits (including both adults and children), with a relatively small variation across the states (e.g., 20% in New York vs. 24% in Nebraska). Analysis of the 2010 data gave similar results for the ED utilization by children.ConclusionBy using large population-based data, we found a substantial burden of ED visits at both patient- and visit-levels. These findings provide a strong foundation for policy makers and professional organizations to strengthen emergency care for children.
Highlights
Epidemiological surveillance data for emergency department (ED) visits by children are imperative to guide resource allocation and to develop health policies that advance pediatric emergency care
These findings provide a strong foundation for policy makers and professional organizations to strengthen emergency care for children. [West J Emerg Med. 2017;18(8)1042-1046.]
At the visit-level, children accounted for 22% of all ED visits, consistent with the estimates using nationally-representative databases — e.g., the Nationwide Emergency Department Sample ED visits by Volume 18, no. 6: October 2017
Summary
Epidemiological surveillance data for emergency department (ED) visits by children are imperative to guide resource allocation and to develop health policies that advance pediatric emergency care. There are sparse population-based data on patient-level information (e.g., the number of children who present to the emergency department [ED]). In this context, we aimed to investigate both the patient- and visit-level rates of ED utilization by children. To guide appropriate resource allocation and advance pediatric emergency care, surveillance data of the current ED visits made by children are instrumental. Prior reports have documented visit-level information for U.S children (e.g., the number of ED visits and visit-level ED visit rate),[1,2] there are limited data on patient-level data (e.g., the number of children who present to the ED).[7-9]. Two other multicenter pediatric ED studies have reported that 36%-38% of children who visited the ED had multiple ED visits.[8,9] Yet, since 90% of children are brought to general EDs,[10] focusing on high-volume pediatric centers might cause selection bias
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