Routine Emergency Department Use for Sick Care by Children in the United States

Background. The use of the emergency departments as a regular source of sick care has been increasing, despite the fact that it is costly and is often an inappropriate source of care. This study examines factors associated with routine use of emergency departments by using a national sample of US children. Methods. Data from the 1988 National Health Interview Survey on Child Health, a nationally representative sample of 17 710 children younger than 18 years, was linked to county-level health resource data from the Area Resource File. Bivariate and multivariate analyses were used to assess the association between children's use of emergency departments as their usual sources of sick care and predisposing need and enabling characteristics of the families, as well as availability of health resources in their communities. Results. In 1988 3.4% or approximately 2 million US children younger than 18 years were reported to use emergency departments as their usual sources of sick care. Significant demographic risk factors for reporting an emergency department as a usual source of sick care included black versus white race (odds ratio [OR], 2.08), single-parent versus two-parent families (OR, 1.53), mothers with less than a high school education versus those with high school or more (OR, 1.76), poor versus nonpoor families (OR, 1.76), and living in an urban versus suburban setting (OR, 1.38). Specific indicators of need, such as recurrent health conditions (asthma, tonsillitis, headaches, and febrile seizures), were not associated with routine use of emergency departments for sick care. Furthermore, health insurance status and specifically Medicaid coverage had no association with use of the emergency department as a usual source of sick care. Compared with children who receive well child care in private physicians' offices or health maintenance organizations, children whose sources of well child care were neighborhood health centers were more likely to report emergency departments for sick care (OR, 2.01). Children residing in counties where the supply of primary care physicians was in the top quintile had half the odds (OR, 0.50) of reporting emergency departments as usual sources of sick care.

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Tracking the Rise of Geriatric Emergency Departments in the United States

Journal of Applied Gerontology ◽

10.1177/0733464818813030 ◽

2018 ◽

Vol 39 (8) ◽

pp. 871-879 ◽

Cited By ~ 2

Author(s):

John G. Schumacher ◽

Jon Mark Hirshon ◽

Phillip Magidson ◽

Marilyn Chrisman ◽

Terisita Hogan

Keyword(s):

Emergency Department ◽

Emergency Care ◽

Emergency Departments ◽

The United States ◽

Transitions Of Care ◽

Emergency Department Care ◽

Equipment And Supplies ◽

Care Services ◽

Physical Environments

The traditional model of emergency care no longer fits the growing needs of the over 20 million older adults annually seeking emergency department care. In 2007 a tailored “geriatric emergency department” model was introduced and rapidly replicated among hospitals, rising steeply over the past 5 years. This survey examined all U.S. emergency departments self-identifying themselves as Geriatric Emergency Departments (GEDs) and providing enhanced geriatric emergency care services. It was guided by the recently adopted Geriatric Emergency Department Guidelines and examined domains including, GED identity, staffing, and administration; education, equipment, and supplies; policies, procedures, and protocols; follow-up and transitions of care; and quality improvement. Results reveal a heterogeneous mix of GED staffing, procedures, physical environments and that GEDs’ familiarity with the GED Guidelines is low. Findings will inform emergency departments and gerontologists nationwide about key GED model elements and will help hospitals to improve ED services for their older adult patients.

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Continuity of Primary Care Clinician in Early Childhood

PEDIATRICS ◽

10.1542/peds.113.s5.1917 ◽

2004 ◽

Vol 113 (Supplement_5) ◽

pp. 1917-1925 ◽

Cited By ~ 2

Author(s):

Moira Inkelas ◽

Mark A. Schuster ◽

Lynn M. Olson ◽

Christina H. Park ◽

Neal Halfon

Keyword(s):

Health Care ◽

Logistic Regression ◽

Child Care ◽

Managed Care ◽

Young Children ◽

Care Setting ◽

The United States ◽

Health Care Setting ◽

Well Child Care ◽

Publicly Insured

Objectives. This study uses the first national data on well-child care for young children to 1) assess how many children have a specific clinician for well-child care; 2) identify the health insurance, health care setting, and child and family determinants of having a specific clinician; and 3) assess how parents choose pediatric clinicians. Methods. Data from the National Survey of Early Childhood Health (NSECH), a nationally representative survey of health care quality for young children fielded by the National Center for Health Statistics in 2000, were used to describe well-child care settings for children aged 4 to 35 months. Parents reported the child’s usual setting of well-child care, whether their child has a specific clinician for well-child care, and selection method for those with a clinician. Bivariate and logistic regression analyses are used to identify determinants of having a specific clinician and of provider selection method, including health care setting, insurance, managed care, and child and family characteristics. Results. Nearly all young children aged 4 to 35 months in the United States (98%) have a regular setting, but only 46% have a specific clinician for well-child care. The proportion of young children who have a single clinician is highest among privately insured children (51%) and lowest among publicly insured children (37%) and uninsured children (28%). In multivariate logistic regression including health care and sociodemographic factors, odds of having a specific clinician vary little by health care setting. Odds are lower for children who are publicly insured (odds ratio [OR]: 0.7; 95% confidence interval [CI]: 0.45–0.97) and for Hispanic children with less acculturated parents (OR: 0.6; 95% CI: 0.39–0.91). Odds are higher for children in a health plan with gatekeeping requirements (OR: 1.4; 95% CI: 1.02–1.88). Approximately 13% of young children with a specific clinician were assigned to that provider. Assignment rather than parent choice is more frequent for children who are publicly insured, in managed care, cared for in a community health center/public clinic, Hispanic, and of lower income and whose mother has lower education. In multivariate logistic regression, only lack of health insurance, care in a community health center, and managed care participation are associated with lack of choice. Conclusions. Anticipatory guidance is the foundation of health supervision visits and may be most effective when there is a continuous relationship between the pediatric provider and the parent. Only half of young children in the United States are reported to have a specific clinician for well-child care. Low rates of continuity are found across health care settings. Furthermore, not all parents of children with a continuous relationship exercised choice, particularly among children in safety net health care settings. These provisional findings on a new measure of primary care continuity for children raise important questions about the prevalence and determinants of continuity.

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PEAK LOWER EXTREMITY SOCCER INJURIES OCCUR IMMEDIATELY FOLLOWING GROWTH IN ADOLESCENTS: AN EPIDEMIOLOGIC REVIEW OF EMERGENCY DEPARTMENT VISITS

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00214 ◽

2020 ◽

Vol 8 (4_suppl3) ◽

pp. 2325967120S0021

Author(s):

Aidan P. Wright ◽

Aaron J. Zynda ◽

Jane S. Chung ◽

Philip L. Wilson ◽

Henry B. Ellis ◽

...

Keyword(s):

Emergency Department ◽

Lower Extremity ◽

Emergency Departments ◽

Skeletal Maturity ◽

Epidemiologic Study ◽

The United States ◽

Emergency Department Visits ◽

Injury Surveillance System ◽

Lower Extremity Injuries ◽

Extremity Injuries

BACKGROUND: Soccer has become the most popular youth sport in the world. Within the last decade, there has been limited epidemiologic research on pediatric soccer-related injuries based on sex and age. PURPOSE: To examine trends associated with soccer injuries presenting to emergency departments and to describe differences in injury pattern and location based on sex and age during periods of growth. METHODS: An epidemiologic study was conducted utilizing publicly accessible data from the National Electronic Injury Surveillance System (NEISS). The NEISS compiles Emergency Department (ED) data on all injuries presenting to the approximately 100 participating network hospitals in the United States. Information on all soccer-related injuries occurring in ages 7-19 from January 2009 – December 2018 was extracted and summary statistics were calculated. RESULTS: Approximately 54,287 pediatric soccer-related injuries were identified. The average age for all injuries was 13.3 years, and males (60.50%) presented more often than females (39.50%). Concussions and head injuries (15.57%) were most commonly reported overall, with a greater percentage occurring in females than males (17.44% vs. 14.35%). The ankle (15.3%) was the second most common injury location with females also presenting more commonly than males (18.71% vs. 13.62%). Age and sex-based evaluation noted peaks in lower extremity injuries in females younger than in males. Both ankle (F=13-15 years, M=15-17 years) and knee (F=14 years, M=16 years) injuries peaked at ages coinciding with recognized sex-based lower extremity skeletal maturity (Figure 1). CONCLUSION: Peak pediatric soccer-related ankle and knee injuries presenting to emergency departments occur at different ages in females and males and appear to, on average, coincide with maturation (age 14 in females and 16 in males). Lower extremity injuries significantly increase nearing the completion of lower extremity growth, and may indicate appropriate timing for differential sex-specific injury prevention programs within soccer. [Figure: see text]

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Well-Child Care in Infancy and Emergency Department Use by South Carolina Medicaid Children Birth to 6 Years Old

Southern Medical Journal ◽

10.1097/smj.0b013e31822426c0 ◽

2011 ◽

Vol 104 (8) ◽

pp. 604-608 ◽

Cited By ~ 4

Author(s):

William B. Pittard

Keyword(s):

Emergency Department ◽

South Carolina ◽

Child Care ◽

Emergency Department Use ◽

Well Child Care ◽

Medicaid Children

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Analysis of Inpatient and Emergency Department Serial Troponin Testing Intervals in the United States

The Journal of Applied Laboratory Medicine ◽

10.1093/jalm/jfaa185 ◽

2020 ◽

Author(s):

Andrew Fletcher ◽

Erik Forsman ◽

Brian R Jackson

Keyword(s):

United States ◽

Emergency Department ◽

Median Time ◽

Emergency Departments ◽

The United States ◽

Published Data ◽

Time Interval ◽

Time Intervals ◽

Convenience Sample ◽

Facility Level

Abstract Background Serial measurement of cardiac troponins (cTn) is central to the diagnosis of myocardial infarction. The time intervals between individual measurements may impact the speed and reliability of diagnosis. Published recommendations exist for these time intervals, but there is little previously published data on actual intervals in routine clinical settings. Methods Retrospective analysis of cTn testing intervals was performed from a convenience sample of 37 hospitals. All 37 provided data on inpatient tests and 19 also provided separate data for tests ordered in their emergency departments. Facilities included both academic and community hospitals across the United States. For each facility, the median time interval between serial cTn order collections was determined separately for inpatient orders and emergency department orders. Results The facility-level median time intervals between serial inpatient cTn test orders ranged from 3.17 to 7.32 hours. Facility-level median time intervals between serial emergency department cTn orders ranged from 1.48 to 4.23 hours. There was no observed difference between academic and nonacademic facilities. Conclusion Typical time intervals between serial cTn orders varied widely across hospitals, and in many cases reflected suboptimal care. Time intervals were generally shorter for cTn testing ordered in emergency departments. Existing testing protocols should be re-examined.

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Epidemiologic Comparison of Injured High School Basketball Athletes Reporting to Emergency Departments and the Athletic Training Setting

Journal of Athletic Training ◽

10.4085/1062-6050-49.3.09 ◽

2014 ◽

Vol 49 (3) ◽

pp. 381-388 ◽

Cited By ~ 11

Author(s):

Erica N. Fletcher ◽

Lara B. McKenzie ◽

R. Dawn Comstock

Keyword(s):

High School ◽

Emergency Department ◽

Confidence Interval ◽

Athletic Training ◽

Emergency Departments ◽

Clinical Settings ◽

Consumer Product Safety Commission ◽

Injury Surveillance System ◽

P Values ◽

Training Setting

Context: Basketball is a popular US high school sport with more than 1 million participants annually. Objective: To compare patterns of athletes with basketball-related injuries presenting to US emergency departments from 2005 through 2010 and the high school athletic training setting from the 2005–2011 seasons. Design: Descriptive epidemiology study. Setting: Data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission and the High School Reporting Information Online database. Main Outcome Measure(s): Complex sample weights were used to calculate national estimates of basketball-related injuries for comparison. Patients or Other Participants: Adolescents from 13 to 19 years of age treated in US emergency departments for basketball-related injuries and athletes from 13 to 19 years of age from schools participating in High School Reporting Information Online who were injured while playing basketball. Results: Nationally, an estimated 1 514 957 (95% confidence interval = 1 337 441, 1 692 474) athletes with basketball-related injuries reported to the emergency department and 1 064 551 (95% confidence interval = 1 055 482, 1 073 620) presented to the athletic training setting. Overall, the most frequent injuries seen in the emergency department were lacerations and fractures (injury proportion ratios [IPRs] = 3.45 and 1.72, respectively), whereas those seen in the athletic training setting were more commonly concussions and strains/sprains (IPRs = 2.23 and 1.19, respectively; all P values < .0001). Comparisons of body site and diagnosis combinations revealed additional differences. For example, athletes with lower leg fractures more often presented to the emergency department (IPR = 6.53), whereas those with hand fractures more frequently presented to the athletic training setting (IPR = 1.18; all P values < .0001). Conclusions: Patterns of injury differed among high school basketball players presenting for treatment in the emergency department and the athletic training setting. Understanding differences specific to clinical settings is crucial to grasping the full epidemiologic and clinical picture of sport-related injuries. Certified athletic trainers play an important role in identifying, assessing, and treating athletes with sport-related injuries who might otherwise present to clinical settings with higher costs, such as the emergency department.

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An In Situ Simulation-Based Training Approach to Active Shooter Response in the Emergency Department

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2018.39 ◽

2018 ◽

Vol 13 (02) ◽

pp. 345-352 ◽

Cited By ~ 1

Author(s):

Mark S. Mannenbach ◽

Carol J. Fahje ◽

Kharmene L. Sunga ◽

Matthew D. Sztajnkrycer

Keyword(s):

Emergency Department ◽

Emergency Departments ◽

Low Frequency ◽

Training Model ◽

The United States ◽

Lessons Learned ◽

Added Value ◽

Active Shooter ◽

In Situ Simulation

ABSTRACTWith an increased number of active shooter events in the United States, emergency departments are challenged to ensure preparedness for these low frequency but high stakes events. Engagement of all emergency department personnel can be very challenging due to a variety of barriers. This article describes the use of an in situ simulation training model as a component of active shooter education in one emergency department. The educational tool was intentionally developed to be multidisciplinary in planning and involvement, to avoid interference with patient care and to be completed in the true footprint of the work space of the participants. Feedback from the participants was overwhelmingly positive both in terms of added value and avoidance of creating secondary emotional or psychological stress. The specific barriers and methods to overcome implementation are outlined. Although the approach was used in only one department, the approach and lessons learned can be applied to other emergency departments in their planning and preparation. (Disaster Med Public Health Preparedness. 2019;13:345–352)

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Child Development and Pediatric Sport and Recreational Injuries by Age

Journal of Athletic Training ◽

10.4085/1062-6050-49.3.41 ◽

2014 ◽

Vol 49 (6) ◽

pp. 780-785 ◽

Cited By ~ 21

Author(s):

David C. Schwebel ◽

Carl M. Brezausek

Keyword(s):

United States ◽

Emergency Department ◽

Emergency Departments ◽

Injury Risk ◽

The United States ◽

Emergency Department Visits ◽

Sociocultural Factors ◽

Childhood And Adolescence ◽

Injury Surveillance System ◽

Sport And Recreation

Context: In 2010, 8.6 million children were treated for unintentional injuries in American emergency departments. Child engagement in sports and recreation offers many health benefits but also exposure to injury risks. In this analysis, we consider possible developmental risk factors in a review of age, sex, and incidence of 39 sport and recreational injuries. Objective: To assess (1) how the incidence of 39 sport and recreational injuries changed through each year of child and adolescent development, ages 1 to 18 years, and (2) sex differences. Design Descriptive epidemiology study. Setting: Emergency department visits across the United States, as reported in the 2001–2008 National Electronic Injury Surveillance System database. Patients or Other Participants: Data represent population-wide emergency department visits in the United States. Main Outcome Measure(s) Pediatric sport- and recreation-related injuries requiring treatment in hospital emergency departments. Results: Almost 37 pediatric sport or recreational injuries are treated hourly in the United States. The incidence of sport- and recreation-related injuries peaks at widely different ages. Team-sport injuries tend to peak in the middle teen years, playground injuries peak in the early elementary ages and then drop off slowly, and bicycling injuries peak in the preteen years but are a common cause of injury throughout childhood and adolescence. Bowling injuries peaked at the earliest age (4 years), and injuries linked to camping and personal watercraft peaked at the oldest age (18 years). The 5 most common causes of sport and recreational injuries across development, in order, were basketball, football, bicycling, playgrounds, and soccer. Sex disparities were common in the incidence of pediatric sport and recreational injuries. Conclusions: Both biological and sociocultural factors likely influence the developmental aspects of pediatric sport and recreational injury risk. Biologically, changes in perception, cognition, and motor control might influence injury risk. Socioculturally, decisions must be made about which sport and recreational activities to engage in and how much risk taking occurs while engaging in those activities. Understanding the developmental aspects of injury data trends allows preventionists to target education at specific groups.

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