Recurrent and high-frequency use of the emergency department by pediatric patients. Acad Emerg Med 2014 Apr;21(4):365-73
Date
04/16/2014Pubmed ID
24730398DOI
10.1111/acem.12347Scopus ID
2-s2.0-84898843093 (requires institutional sign-in at Scopus site) 130 CitationsAbstract
OBJECTIVES: The authors sought to describe the epidemiology of and risk factors for recurrent and high-frequency use of the emergency department (ED) by children.
METHODS: This was a retrospective cohort study using a database of children aged 0 to 17 years, inclusive, presenting to 22 EDs of the Pediatric Emergency Care Applied Research Network (PECARN) during 2007, with 12-month follow-up after each index visit. ED diagnoses for each visit were categorized as trauma, acute medical, or chronic medical conditions. Recurrent visits were defined as any repeat visit; high-frequency use was defined as four or more recurrent visits. Generalized estimating equations (GEEs) were used to measure the strength of associations between patient and visit characteristics and recurrent ED use.
RESULTS: A total of 695,188 unique children had at least one ED visit each in 2007, with 455,588 recurrent ED visits in the 12 months following the index visits. Sixty-four percent of patients had no recurrent visits, 20% had one, 8% had two, 4% had three, and 4% had four or more recurrent visits. Acute medical diagnoses accounted for most visits regardless of the number of recurrent visits. As the number of recurrent visits per patient rose, chronic diseases were increasingly represented, with asthma being the most common ED diagnosis. Trauma-related diagnoses were more common among patients without recurrent visits than among those with high-frequency recurrent visits (28% vs. 9%; p<0.001). High-frequency recurrent visits were more often within the highest severity score classifications. In multivariable analysis, recurrent visits were associated with younger age, black or Hispanic race or ethnicity, and public health insurance.
CONCLUSIONS: Risk factors for recurrent ED use by children include age, race and ethnicity, and insurance status. Although asthma plays an important role in recurrent ED use, acute illnesses account for the majority of recurrent ED visits.
Author List
Alpern ER, Clark AE, Alessandrini EA, Gorelick MH, Kittick M, Stanley RM, Dean JM, Teach SJ, Chamberlain JM, Pediatric Emergency Care Applied Research Network (PECARN)MESH terms used to index this publication - Major topics in bold
Acute DiseaseAdolescent
Child
Child, Preschool
Chronic Disease
Emergency Service, Hospital
Female
Follow-Up Studies
Humans
Infant
Infant, Newborn
Logistic Models
Male
Multivariate Analysis
Recurrence
Retrospective Studies
Risk Factors
Severity of Illness Index
United States
Wounds and Injuries
