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Variation in Pediatric Care Between Academic and Nonacademic US Emergency Departments, 1995-2010
Joyce Li1, Michael C Monuteaux, Richard G Bachur
1From the Division of Emergency Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA.
Insights
Nonacademic emergency departments (NA-EDs) utilized more resources for pediatric patients with croup, bronchiolitis, and seizures compared to academic EDs (A-EDs). Further investigation is needed to understand these differences in pediatric emergency care.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Resource Utilization
- Comparative Healthcare Analysis
Background:
- Emergency departments (EDs) manage a high volume of pediatric visits for common conditions.
- Understanding resource utilization differences between academic EDs (A-EDs) and nonacademic EDs (NA-EDs) is crucial for optimizing pediatric care.
- Previous studies have not comprehensively compared resource use for specific pediatric conditions across different ED settings.
Purpose of the Study:
- To compare resource utilization for common pediatric conditions treated in academic versus nonacademic emergency departments.
- To identify variations in testing, medication, and disposition patterns between A-EDs and NA-EDs for pediatric patients.
- To provide data for future investigations into disparities in pediatric emergency care.
Main Methods:
- Retrospective, cross-sectional descriptive study using National Hospital Ambulatory Medical Care Survey data (1995-2010).
- Included children (<18 years) with asthma, bronchiolitis, croup, gastroenteritis, fever, febrile seizure, or afebrile seizure.
- Compared proportions of testing, medications, and disposition between A-EDs and NA-EDs.
Main Results:
- Analysis represented approximately 450 million pediatric visits.
- Resource utilization and disposition were largely comparable, with notable exceptions.
- NA-EDs showed higher admission rates for bronchiolitis (18% vs 10%) and increased use of radiographs for bronchiolitis (56% vs 45%) and croup (27% vs 6%).
- NA-EDs performed more lumbar punctures for febrile seizures (14% vs 0%) and head CT scans for afebrile seizures (34% vs 21%).
Conclusions:
- Higher resource utilization and admission rates were observed in NA-EDs for pediatric patients with croup, bronchiolitis, and seizures.
- These findings highlight variations in care delivery between academic and nonacademic pediatric emergency settings.
- Further research is warranted to explore the reasons behind these observed differences in resource utilization.
Objectives:
The aim of this study was to describe the resource utilization for children with common pediatric conditions treated in academic and nonacademic emergency departments (EDs).
Methods:
We performed a retrospective, cross-sectional descriptive study using the National Hospital Ambulatory Medical Care Survey Data from 1995 to 2010 including children less than 18 years old with a diagnosis of asthma, bronchiolitis, croup, gastroenteritis, fever, febrile seizure, or afebrile seizure. Academic EDs (A-ED) were those with greater than 25% of patients seen by a trainee. For each condition, we reported the proportion of testing, medications, and disposition between A-ED and nonacademic EDs (NA-ED).
Results:
From 1995 to 2010, approximately 450,000,000 estimated pediatric visits are represented by the survey based on 122,811 actual visits. For most common conditions, testing and disposition were comparable; however, some variation was noted. Among patients with bronchiolitis, a higher proportion of patients was admitted and had radiographs in NA-EDs (18% vs 10% and 56% vs 45%, respectively). For children with croup, radiographs were performed more often at NA-EDs (27% vs 6%). Among those with febrile seizures, more lumbar punctures were performed in NA-EDs (14% vs 0%). In children with afebrile seizures, more head computed tomography scans were obtained at NA-EDs (34% vs 21%).
Conclusion:
Among pediatric patients with croup, bronchiolitis, and febrile and afebrile seizure, higher resource utilization and admissions were observed in NA-EDs. These preliminary findings from a national survey require a more detailed investigation into the variation in care between A-ED and NA-ED settings.
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