Comparison of Emergency Care Delivered to Children and Young Adults With Complex Chronic Conditions Between Pediatric and General Emergency Departments

• Published in: Academic emergency medicine 2014-07, Vol.21 (7), p.778-784
• Main Authors: Murtagh Kurowski, Eileen, Byczkowski, Terri, Grupp‐Phelan, Jacqueline M., Macy, Michelle L.
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Child, Preschool; Chronic Disease - therapy; Cross-Sectional Studies; Disease Progression; Emergency medical care; Emergency Service, Hospital - classification; Emergency Service, Hospital - economics; Emergency Service, Hospital - statistics & numerical data; Female; Health care expenditures; Humans; Infant; Infant, Newborn; Logistic Models; Male; Odds Ratio; Outcome Assessment (Health Care); Patient Admission - standards; Patient Admission - statistics & numerical data; Patient admissions; Patient Discharge - statistics & numerical data; Pediatrics; Pediatrics - classification; Pediatrics - economics; Pediatrics - statistics & numerical data; Transition to Adult Care - standards; Transition to Adult Care - statistics & numerical data; United States; Young Adult; Young adults
• ISSN: 1069-6563; 1553-2712
• DOI: 10.1111/acem.12412

Objectives Increasing attention is being paid to medically complex children and young adults, such as those with complex chronic conditions, because they are high consumers of inpatient hospital days and resources. However, little is known about where these children and young adults with complex chronic conditions seek emergency care and if the type of emergency department (ED) influences the likelihood of admission. The authors sought to generate nationwide estimates for ED use by children and young adults with complex chronic conditions and to evaluate if being of the age for transition to adult care significantly affects the site of care and likelihood of hospital admission. Methods This was a cross‐sectional study using discharge data from the 2008 Nationwide Emergency Department Sample (NEDS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality to evaluate visits to either pediatric or general EDs by pediatric‐aged patients (17 years old or younger) and transition‐aged patients (18 to 24 years old) with at least one complex chronic condition. The main outcome measures were hospital admission, ED charges for treat‐and‐release visits, and total charges for admitted patients. Results In 2008, 69% of visits by pediatric‐aged and 92% of visits by transition‐aged patients with multiple complex chronic conditions occurred in general EDs. Not surprisingly, pediatric age was the strongest predictor of seeking care in a pediatric ED (odds ratio [OR] = 15.86; 95% confidence interval [CI] = 12.3 to 20.5). Technology dependence (OR = 1.56; 95% CI =1.2 to 2.0) and presence of multiple complex chronic conditions (OR = 1.39; 95% CI = 1.2 to 1.6) were also associated with higher odds of seeking care in a pediatric ED. When controlling for patient and hospital characteristics, type of ED was not a significant predictor of admission (p = 0.87) or total charges (p = 0.26) in either age group. Conclusions Overall, this study shows that, despite their complexity, the vast majority of children and young adults with multiple complex chronic conditions are cared for in general EDs. When controlling for patient and hospital characteristics, the admission rate and total charges for hospitalized patients did not differ between pediatric and general EDs. This result highlights the need for increased attention to the care that these medically complex children and young adults receive outside of pediatric‐specialty centers. These results also