Adult patients with chronic pediatric disorders continue to use pediatric ED

Because pediatric specialists, hospitals and institutions often remain the preferred sources of care for transition patients — adult patients with chronic pediatric disorders — these health care providers must be equipped to treat the unique medical complications experienced by this population, according to recent study data.

“Transition patients’ chronic pediatric disorders may be unfamiliar to adult-care physicians, yet their acute conditions may involve areas of adult medicine unfamiliar to pediatric physicians,” wrote researchers at the Primary Children’s Medical Center in Salt Lake City, who conducted the trial. “As increasing numbers of children with chronic pediatric disorders survive into adulthood, answers to these questions will take on increasing urgency.”

A retrospective descriptive study was conducted to examine adult patients with chronic pediatric disorders seen in the hospital’s pediatric ED during 2005. Outcome measures included number of patients, presenting complaints, hospital admissions and physicians’ preparation for treating this population.

Adults comprised 1% of the 43,621 patient encounters in the pediatric ED, according to the researchers, and of this population, 44% were considered transition patients, with ages ranging from 19 to 37 years. Seventy-seven percent of transition patients also had an ongoing relationship with at least one pediatric subspecialty clinic associated with the hospital, and many visited multiple clinics. Twenty percent did not have primary care providers, but 83% of these patients had relationships with subspecialty clinics.

Results also indicated that most patients presented with neurologic problems, although 45% of medical complaints had no direct correlation with the patient’s chronic pediatric disorder. Ninety-eight percent of complaints, however, fell within the attending physicians’ training and experience.

The researchers also noted that 86% of patient encounters resulted in consultation with at least one pediatric subspecialty service, and only 7% required no diagnostic tests or medical or surgical procedures.

Data also showed that transition patients were 2.1 times more likely to be admitted to the hospital (95% CI, 1.8-2.5) than patients aged younger than 19 years. Median length of hospital stay — 4 days — was also longer in this population when compared with 2 days for pediatric patients (P<.001). Transition patients were also 4.5 times (95% CI, 3.3-6.1) more likely to be admitted to the ICU during their stay when compared with pediatric patients.

“We found that adults with chronic pediatric disorders use the pediatric ED in substantial numbers,” the researchers wrote. “These patients require a large quantity of diagnostic and treatment resources relative to their numbers. … Unless large-scale policy decisions are made to provide acute care for these patients at adult facilities, pediatric hospitals should be prepared with adequate resources and training to deal with these complex adult patients.”

In an accompanying editorial, Clarissa Kripke, MD,and Kevin Grumbach, MD, both with the department of family and community medicine at the University of California, San Francisco, wrote: “With growing national attention to expanding health insurance coverage and centering the delivery of care around patient-centered medical homes, now is the time to implement reforms in payment, training, and health care organization so that all patients with complex chronic conditions are assured coordinated, comprehensive, quality health care across their life span.”

Kripke and Grumbach also said the transfer of pediatric and adult care is too abrupt, and that the process of moving patients from a one setting to the next should be a collaborative process involving the provider, the patient and the patient’s family.

Kripke C. Arch Pediatr Adolesc Med. 2010;164:581-582.

McDonnell WM. Arch Pediatr Adolesc Med. 2010;164:572-576.