TY - JOUR
T1 - The Care of Adult Patients in Pediatric Emergency Departments
AU - Samuels-Kalow, Margaret
AU - Neuman, Mark I.
AU - Rodean, Jonathan
AU - Marin, Jennifer R.
AU - Aronson, Paul L.
AU - Hall, Matthew
AU - Freedman, Stephen B.
AU - Morse, Rustin B.
AU - Cohen, Eyal
AU - Simon, Harold K.
AU - Shah, Samir S.
AU - Alpern, Elizabeth R.
N1 - Funding Information:
This work was presented at the annual meetings of the Society for Academic Emergency Medicine (May 15–18, 2018; Indianapolis, Ind) and Pediatric Academic Societies (May 5–8, 2018; Toronto, Canada). Authorship statement: M.S.-K. and E.R.A. conceptualized the study; assisted with the design, analysis, and interpretation of the data; and drafted the manuscript. J.R. and M.H. provided statistical expertise. M.I.N. M.H. and J.R. contributed to the design of the study. M.I.N. J.R. J.R.M. P.L.A. M.H. S.B.F. R.B.M. E.C. H.K.S. and S.S.S. participated in interpretation of the data and critical revision of the manuscript. Financial disclosure: P.L.A. is supported by Clinical and Translational Science Awards grant number KL2 TR001862 from the National Center for Advancing Translational Science, a component of the National Institutes of Health. S.B.F. is supported by the Alberta Children's Hospital Professorship in Child Health and Wellness. There was no external funding for this manuscript.
Funding Information:
Financial disclosure: P.L.A. is supported by Clinical and Translational Science Awards grant number KL2 TR001862 from the National Center for Advancing Translational Science, a component of the National Institutes of Health. S.B.F. is supported by the Alberta Children's Hospital Professorship in Child Health and Wellness. There was no external funding for this manuscript.
Publisher Copyright:
© 2019 Academic Pediatric Association
PY - 2019/11/1
Y1 - 2019/11/1
N2 - 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.
AB - 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.
KW - adult patients
KW - pediatric emergency medicine
KW - transitions in care
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U2 - 10.1016/j.acap.2019.03.004
DO - 10.1016/j.acap.2019.03.004
M3 - Article
C2 - 30853574
AN - SCOPUS:85064075472
SN - 1876-2859
VL - 19
SP - 942
EP - 947
JO - Academic Pediatrics
JF - Academic Pediatrics
IS - 8
ER -