Complexity and Severity of Pediatric Patients Treated at United States Emergency Departments


Hudgins JD, Monuteaux MC, Bourgeois FT, Nigrovic LE, Fine AM, Lee LK, Mannix R, Lipsett SC, Neuman MI. Complexity and Severity of Pediatric Patients Treated at United States Emergency Departments. J Pediatr 2017;186:145-149 e1.

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OBJECTIVE: To compare the complexity and severity of presentation of children in general vs pediatric emergency departments (EDs). STUDY DESIGN: We performed a cross-sectional study of pediatric ED visits using the National Emergency Department Sample from 2008 to 2012. We classified EDs as "pediatric" if >75% of patients were <18 years old; all other EDs were classified as "general." The presence of an International Classification of Diseases, Ninth Revision code for a complex chronic condition was used as an indicator of patient complexity. Patient severity was evaluated with the severity classification system. In addition, rates of critical procedures and hospitalization were assessed. RESULTS: We identified 9.6 million encounters to pediatric EDs and 169 million to general EDs. Younger children account for a greater proportion of visits at pediatric EDs than general EDs; children <1 year of age account for 18% of visits to a pediatric ED compared with 9% of visits to a general ED (P < .01). Encounters at pediatric EDs had greater complexity (5% vs 2%; P < .01). Although severity classification system scores did not significantly differ by ED type, pediatric EDs had greater rates of hospitalization (10% vs 4%). CONCLUSIONS: Pediatric EDs provided care to a greater proportion of medically complex children than general EDs and had greater rates of hospitalization. This information may inform educational efforts in residency or postgraduate training to ensure high-quality care for children with complex health care needs.


Hudgins, Joel DMonuteaux, Michael CBourgeois, Florence TNigrovic, Lise EFine, Andrew MLee, Lois KMannix, RebekahLipsett, Susan CNeuman, Mark IengJ Pediatr. 2017 Jul;186:145-149.e1. doi: 10.1016/j.jpeds.2017.03.035. Epub 2017 Apr 7.

Last updated on 06/21/2018