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Evaluating Pediatric Emergency Care Within Epic Cosmos
Sriram Ramgopal1,2, Joseph J Zorc3, James M Gray4
1Department of Pediatrics, Division of Emergency Medicine, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
Insights
This study analyzed over 41 million pediatric emergency department (ED) encounters, revealing common chief complaints and quality improvement (QI) metrics for pediatric emergency care. The findings demonstrate the utility of the Epic Cosmos platform for assessing care quality.
Area of Science:
- Pediatric Emergency Medicine
- Health Informatics
- Quality Improvement Science
Background:
- Pediatric emergency department (ED) utilization is substantial, necessitating robust data for quality assessment.
- The Epic Cosmos platform offers a large-scale dataset for analyzing pediatric ED encounters.
- Understanding care patterns and quality metrics is crucial for improving pediatric emergency care.
Purpose of the Study:
- To characterize pediatric ED encounters using the Epic Cosmos database.
- To evaluate selected quality improvement (QI) measures for common pediatric conditions treated in the ED.
- To assess the utility of a large electronic health record database for pediatric emergency medicine research.
Main Methods:
- Retrospective analysis of over 41 million pediatric ED encounters in the US from January 2020 to June 2025.
- Summarized patient demographics, visit characteristics, chief complaints, and triage acuity (Emergency Severity Index).
- Evaluated QI metrics for conditions including asthma, head injury, viral illness, croup, dehydration, and lacerations.
Main Results:
- The study included 41,735,030 encounters; median age was 6 years, with 52% males. Most patients were White, non-Hispanic, publicly insured, and resided in urban areas.
- Common chief complaints included fever (16.6%), cough (11.7%), vomiting (8.2%), and abdominal pain (7.4%).
- QI metrics showed variation: e.g., 86.3% corticosteroid use for asthma, 18.6% brain CT for head injury, and 4.8% antibiotic use for viral illness.
Conclusions:
- Pediatric ED encounters in Epic Cosmos reflect national care patterns.
- The platform is valuable for assessing pediatric emergency care quality and identifying areas for improvement.
- Findings should be interpreted with awareness of potential data variability in coding and institutional representation.
Objectives:
To describe the characteristics and selected quality improvement (QI) measures of pediatric emergency department (ED) encounters within Epic Cosmos.
Methods:
We performed a retrospective study within Cosmos of all pediatric (<18 years) US-based ED encounters between January 1, 2020, and June 30, 2025. We summarized demographics, visit characteristics, and diagnoses. We evaluated QI metrics for key conditions.
Results:
We included 41,735,030 ED encounters from 18,757,872 distinct patients. The median encounter age was 6 years (IQR 2 to 12) and 52.0% were male. Most patients were White (58.7%), non-Hispanic (67.4%), publicly insured (58.5%), urban-dwelling (85.7%), and nearly half resided in the South (47.6%). The most common chief complaints were fever (16.6%), cough (11.7%), vomiting (8.2%), and abdominal pain (7.4%). Most patients were triaged as Emergency Severity Index (ESI) 4 (45.4%) or ESI 3 (35.7%), and 88.3% were discharged from the ED. QI metric analysis demonstrated corticosteroid use for asthma in 86.3% of encounters, chest radiography among children with asthma in 42.8%, brain CT for head injury in 18.6%, antibiotic use for viral illness in 4.8%, corticosteroid use for croup in 91.7%, intravenous fluid use for dehydration in 10.7%, and topical anesthesia use for lacerations in 56.4%.
Conclusions:
We characterized pediatric ED encounters within the Epic Cosmos platform, which is consistent with national patterns of pediatric ED care. These findings highlight the utility of Cosmos for assessing care quality and variability in pediatric emergency medicine, although findings should be interpreted cautiously given variability in coding, data mapping, and institutional representation.
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