Characteristics of recurrent utilization in pediatric emergency departments

Area of Science:

• Pediatric Emergency Medicine
• Healthcare Quality Improvement
• Health Services Research

Background:

• Frequent emergency department (ED) utilization by children is a focus for quality improvement initiatives.
• Understanding the characteristics of high-frequency ED users is crucial for targeted interventions.
• This study examines pediatric ED visit patterns and associated healthcare services.

Purpose of the Study:

• To compare the characteristics and ED health services utilized by children based on their ED visit frequency.
• To identify patient demographics and clinical factors associated with frequent ED use in pediatric populations.
• To inform strategies for optimizing care for high-utilizing pediatric ED patients.

Main Methods:

• Retrospective analysis of 3,263,330 ED visits by 1,896,547 children (0-18 years) across 37 EDs in 2011.
• Categorization of children based on the number of ED visits within 365 days.
• Multivariable regression analysis to assess relationships between patient characteristics, ED services (medications, testing, admission), and visit frequency.

Main Results:

• Children with ≥4 ED visits (8% of patients) accounted for 24% of all visits and 31% of total ED costs ($1.4 billion).
• Increasing visit frequency correlated with a higher proportion of younger children (<1 year) and fewer children with chronic conditions.
• Frequent ED users (≥4 visits) were more likely to have visits without medication, testing, or hospital admission compared to single-visit patients.

Conclusions:

• A small group of frequent pediatric ED users drives a disproportionate share of utilization and costs.
• Infants without chronic conditions are a key subgroup among frequent ED users, often receiving less intensive care during visits.
• Findings highlight the need for targeted interventions for specific high-utilizing pediatric populations to improve care and reduce costs.