Pediatric Emergency Department Visits in the United States, 2003-05

Purpose: To estimate the frequency and characteristics of visits to US hospital emergency departments (EDs) by children and adolescents under 18 years of age.

Methods: Data were analyzed from the 2003-05 National Hospital Ambulatory Medical Care Survey (NHAMCS), an annual national probability sample survey of visits to EDs in the US, and were weighted to produce national estimates. Three years of data were combined to produce more reliable estimates.

Results: From 2003-05, children and adolescents on average made 28.3 million annual ED visits, approximately 25% of all ED visits. Visit rates (per 100 persons) by age group were: <1 year (94.8), 1-4 (56.3), 5-12 (27.6), and 13-17 (31.5). Most visits (70.3%) occurred outside normal business hours (Monday-Friday, 9am-5pm). The expected source of payment was Medicaid/SCHIP for 41% of visits, and 10% were uninsured. Of the 1.7 million ambulance arrivals, contusion with intact skin was the top diagnosis. There were 10.8 million injury-related visits versus 17.5 million visits for illness. Pain level was often not recorded (17.5%) for injury-related visits. Only 4.1% of ED visits resulted in hospital admission. Visits resulting in admission or transfer were highest for infants <1 year (8.6%).

Conclusions: Utilization, conditions seen, and admission or transfer status of pediatric ED visits vary by age; therefore, when analyzing ED data for children and adolescents, it is important to examine both overall visits by patients under 18 years of age and age subgroups. The results of this study may help policymakers model emergency medical services for children and adolescents.