Characterizing pediatric high frequency users of California emergency departments

Area of Science:

• Pediatric Health Services Research
• Healthcare Utilization Studies
• Public Health Policy

Background:

• Emergency department (ED) utilization has risen significantly over recent decades.
• Research has primarily focused on adult frequent ED users, with limited investigation into pediatric populations.
• Understanding patterns of pediatric ED use is crucial for resource allocation and care improvement.

Purpose of the Study:

• To evaluate pediatric emergency department (ED) utilization patterns in California.
• To identify and characterize frequent users of pediatric ED services.
• To inform strategies for managing high-demand ED users in pediatric populations.

Main Methods:

• A retrospective, multi-facility study analyzed statewide ED visit data for children aged 1-17 years in California.
• Patients were categorized as occasional (1-5 visits) or frequent (>5 visits) ED users based on visits in the year preceding their last visit in 2016.
• Demographic and clinical characteristics were compared between occasional and frequent pediatric ED users.

Main Results:

• The study included 690,130 children with 1,238,262 ED visits.
• Frequent users (≥6 visits), representing 2.3% of patients, accounted for 9.3% of all ED visits.
• A significant majority (67%) of frequent pediatric ED users did not visit a dedicated pediatric ED, and over 40% utilized multiple hospitals.

Conclusions:

• Most children with frequent ED visits do not access specialized pediatric EDs.
• Factors strongly associated with frequent pediatric ED utilization include patient age, insurance payer (Medicare/Medicaid), and a history of hospital admission or transfer.
• These findings highlight the need for targeted interventions and care coordination for high-utilizing pediatric populations.