The Care of Adult Patients in Pediatric Emergency Departments

Margaret Samuels-Kalow, Mark I. Neuman, Jonathan Rodean, Jennifer R. Marin, Paul L. Aronson, Matthew Hall, Stephen B. Freedman, Rustin B Morse, Eyal Cohen, Harold K. Simon, Samir S. Shah, Elizabeth R. Alpern

Research output: Contribution to journalArticle

Abstract

Objective: Adult patients are increasingly receiving care in pediatric emergency departments (PEDs), but little is known about the epidemiology of these visits. The goals of this study were to examine the characteristics of adult patients (≥21 years) treated in PEDs and to describe the variation in resource utilization across centers. Methods: We conducted a cross-sectional study examining visits to 30 PEDs (2012–2016) using the Pediatric Health Information System. Visits were categorized using All Patient Refined Diagnosis Related Groups and compared between age cohorts. We used multivariable logistic models to examine variation in demographics, utilization, testing, treatment, and disposition. Results: There were 12,958,626 visits to the 30 PEDs over 5 years; 70,636 (0.6%) were by adults. Compared with children, adult patients had more laboratory testing (49% vs 34%), diagnostic imaging (32% vs 29%), and procedures (48% vs 31%), and they were more often admitted (17% vs 11%) or transferred (21% vs 0.7%) (P <.001 for all). In multivariable analysis, older age, black race, Hispanic ethnicity, and private insurance were associated with decreased odds of admission in adults seen in PEDs. Across PEDs, the admission rates (7%–25%) and transfer rates (6%–46%) for adults varied. Conclusions: Adult patients cared for at PEDs have higher rates of testing, diagnostic imaging, procedures, and admission or transfer. There is wide variation in the care of adults in PEDs, highlighting the importance of further work to identify the optimal approach to adults who present for care in pediatric centers.

Original languageEnglish (US)
JournalAcademic Pediatrics
DOIs
StatePublished - Jan 1 2019

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Hospital Emergency Service
Patient Care
Pediatrics
Diagnostic Imaging
Health Information Systems
Diagnosis-Related Groups
Insurance
Hispanic Americans
Epidemiology
Cross-Sectional Studies
Logistic Models
Demography

Keywords

  • adult patients
  • pediatric emergency medicine
  • transitions in care

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Samuels-Kalow, M., Neuman, M. I., Rodean, J., Marin, J. R., Aronson, P. L., Hall, M., ... Alpern, E. R. (2019). The Care of Adult Patients in Pediatric Emergency Departments. Academic Pediatrics. https://doi.org/10.1016/j.acap.2019.03.004

The Care of Adult Patients in Pediatric Emergency Departments. / Samuels-Kalow, Margaret; Neuman, Mark I.; Rodean, Jonathan; Marin, Jennifer R.; Aronson, Paul L.; Hall, Matthew; Freedman, Stephen B.; Morse, Rustin B; Cohen, Eyal; Simon, Harold K.; Shah, Samir S.; Alpern, Elizabeth R.

In: Academic Pediatrics, 01.01.2019.

Research output: Contribution to journalArticle

Samuels-Kalow, M, Neuman, MI, Rodean, J, Marin, JR, Aronson, PL, Hall, M, Freedman, SB, Morse, RB, Cohen, E, Simon, HK, Shah, SS & Alpern, ER 2019, 'The Care of Adult Patients in Pediatric Emergency Departments', Academic Pediatrics. https://doi.org/10.1016/j.acap.2019.03.004
Samuels-Kalow M, Neuman MI, Rodean J, Marin JR, Aronson PL, Hall M et al. The Care of Adult Patients in Pediatric Emergency Departments. Academic Pediatrics. 2019 Jan 1. https://doi.org/10.1016/j.acap.2019.03.004
Samuels-Kalow, Margaret ; Neuman, Mark I. ; Rodean, Jonathan ; Marin, Jennifer R. ; Aronson, Paul L. ; Hall, Matthew ; Freedman, Stephen B. ; Morse, Rustin B ; Cohen, Eyal ; Simon, Harold K. ; Shah, Samir S. ; Alpern, Elizabeth R. / The Care of Adult Patients in Pediatric Emergency Departments. In: Academic Pediatrics. 2019.
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abstract = "Objective: Adult patients are increasingly receiving care in pediatric emergency departments (PEDs), but little is known about the epidemiology of these visits. The goals of this study were to examine the characteristics of adult patients (≥21 years) treated in PEDs and to describe the variation in resource utilization across centers. Methods: We conducted a cross-sectional study examining visits to 30 PEDs (2012–2016) using the Pediatric Health Information System. Visits were categorized using All Patient Refined Diagnosis Related Groups and compared between age cohorts. We used multivariable logistic models to examine variation in demographics, utilization, testing, treatment, and disposition. Results: There were 12,958,626 visits to the 30 PEDs over 5 years; 70,636 (0.6{\%}) were by adults. Compared with children, adult patients had more laboratory testing (49{\%} vs 34{\%}), diagnostic imaging (32{\%} vs 29{\%}), and procedures (48{\%} vs 31{\%}), and they were more often admitted (17{\%} vs 11{\%}) or transferred (21{\%} vs 0.7{\%}) (P <.001 for all). In multivariable analysis, older age, black race, Hispanic ethnicity, and private insurance were associated with decreased odds of admission in adults seen in PEDs. Across PEDs, the admission rates (7{\%}–25{\%}) and transfer rates (6{\%}–46{\%}) for adults varied. Conclusions: Adult patients cared for at PEDs have higher rates of testing, diagnostic imaging, procedures, and admission or transfer. There is wide variation in the care of adults in PEDs, highlighting the importance of further work to identify the optimal approach to adults who present for care in pediatric centers.",
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AU - Freedman, Stephen B.

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