Pediatric patient volume in United States emergency departments: Differences in patient populations

Most emergency departments (EDs) have low pediatric annual volume, which is associated with worse clinical outcomes. The demographic characteristics of who presents to low- vs. high-volume EDs is not well understood.

We performed a retrospective, cross-sectional study of patients aged 0-18 years using the 2022 National Emergency Department Sample. We divided pediatric volume based on known standards: low volume, <1800 visits; medium volume, 1800-4999 visits; medium-high volume, 5000-9999 visits, and high volume, ≥10,000 visits. We calculated survey-weighted frequencies of patient-level demographic and ED-level characteristics, reporting proportions and 95% confidence intervals, as well as proportion differences.

The sample included 6,094,603 ED pediatric visits (population estimate: 26,443,822 ED visits). Low-volume compared to high-volume EDs were less likely to treat infants <1 year (proportion difference - 5.5%, 95% CI -6.2, -4.7%) and younger children aged 1-5 years (proportion difference - 7.8%, 95% CI -8.9, -6.7%). Low-volume compared to high-volume EDs saw higher proportions of children of non-Hispanic Native American (proportion difference 1.0%, 95% CI 0.1, 2.0%) and White race and ethnicity (proportion difference 33.2%, 95% CI 28.4, 38.0%). Low-volume EDs were more often rural (69%).

This national cross-sectional study of US EDs found pediatric patient population differences in age and race and ethnicity based on annual pediatric ED volume. This study reports contemporary data on differences in patient populations presenting to EDs based on pediatric patient volume which is important to inform national and institutional policies to apply focused interventions to improve quality of care in EDs with different pediatric volumes.