Emergency Department Utilization by Children in the USA, 2010-2011

Introduction: Epidemiological surveillance data for emergency department (ED) visits by children areimperative to guide resource allocation and to develop health policies that advance pediatric emergencycare. However, there are sparse population-based data on patient-level information (e.g., the number ofchildren who present to the emergency department [ED]). In this context, we aimed to investigate boththe patient- and visit-level rates of ED utilization by children.Methods: This was a retrospective cohort study using population-based multipayer data – state EDdatabases (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 childrenaged <18 years who presented to the ED and described the patient-level ED visit rate, visit-level ED visitrate, and proportion of all ED visits made by children. We conducted the analysis using the 2011 SEDDand SID data. We also repeated the analysis using the 2010 data to determine the consistency of theresults across different years.Results: In 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 thesechildren, 25% presented to EDs 2-3 times per year with an approximately 1.5-fold variation across thestates (e.g., 19% in Utah vs. 28% in Florida). In addition, 5% presented to EDs ≥4 times per year. At thevisit-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 arelatively small variation across the states (e.g., 20% in New York vs. 24% in Nebraska). Analysis of the2010 data gave similar results for the ED utilization by children.Conclusion: By using large population-based data, we found a substantial burden of ED visits at bothpatient- and visit-levels. These findings provide a strong foundation for policy makers and professionalorganizations to strengthen emergency care for children