Sociodemographic characteristics may help predict nonemergent ED use

Children from high-income families who had private insurance were most likely to frequent EDs for diagnoses that could be treated by a primary care physician; however, out-of-pocket ED expenditures remained the highest for uninsured children.

“Our findings can help ED providers working with community pediatricians and family physicians to identify and educate parents about nonemergent ED use,” the researchers wrote — an important priority in light of the approximate 20% increase in the annual number of ED visits that occurred during the past decade.

They analyzed 5,512 person-years of data included in a nationally representative sample of children aged 0 to17 years who participated in the 2002-2005 Medical Expenditure Panel Survey (MEPS).

Influenza or other viral illness was the most common overall diagnosis in ED visits, the researchers found, but diagnosis varied substantially by patient sociodemographic characteristics. For example, minor injury accounted for 86% (n=318) of visits among children aged 6 to 17 years vs. 13% of visits (n=50) among children aged 0 to 5 years. Similarly, otitis media ED visits were more prevalent among children aged 0 to 5 years (n=264) compared with children aged 6 to 17 years (n=118).

When stratified by age, adolescents aged 12 to 17 years were most likely to visit the ED (29.7%), followed by those aged 6 to 11 years (28.9%), children aged 2 years and younger (22.1%) and children aged 3 to 5 years (19.3%).

“Although the MEPS data were not suited to study causative mechanisms for nonemergent ED use, evidence from the literature suggests that predisposing factors such as age, [sex] and race; enabling factors such as health literacy, knowledge or education, insurance coverage and the availability and ease of primary care services; and the perceived need for urgency can all play a role,” the researchers wrote.

Additional data indicated nonemergent ED use was less likely among non-Hispanic black children vs. non-Hispanic white children (P=.03) and more likely among girls vs. boys (P=.02).

The researchers offered several possible suggestions to alleviate the overburdened health system, including collaborations between EDs and local physicians to create an after-hours telephone line to advise patients concerning the necessity of visiting an ED and the creation of after-hours clinics.

Ben-Isaac E. Pediatrics. 2010;125: 454-459.