Trends in Emergency Department Visits for Children, 2016-2023

To evaluate longitudinal changes in diagnoses related to emergency department (ED) utilization and associated costs among children in US EDs.

We performed a serial cross-sectional study using the 2016-2023 Nationwide Emergency Department Sample, a nationally representative all-payor ED sample. We evaluated longitudinal changes in diagnoses (using the Diagnosis Grouping System) and costs (inflation adjusted 2023 dollars) over time overall utilizing negative binomial regression and log-linear regression, respectively. We then performed interrupted time-series analyses to account for the onset of the COVID-19 pandemic in 2020.

We identified 198,256,299 ED encounters. Overall trends shifted by diagnosis, with increases in psychiatric/behavioral diseases and substance abuse (+2.8% annually; 95% CI, 1.2, 4.4) and endocrine/metabolic/nutritional diseases (+3.7%; 95% CI, 0.4, 7.2). Several diagnoses declined, including skin/soft tissue disease (-9.0%; 95% CI, -13.0, -4.8), urinary tract disease (-4.9%; 95% CI, -7.1, -2.7), and trauma (-4.6%; 95% CI, -7.1, -2.1). In time series analyses, the COVID-19 pandemic was associated with sharp declines in encounters, followed by post-pandemic increases, especially for eye disease (+27.8% annually; 95% CI, 21.5, 34.5), ear, nose and throat (ENT), dental/mouth disease (+20.0%; 95% CI, 15.4, 24.7), fluid/electrolyte disorders (+19.7%; 95% CI, 13.9, 25.7), and respiratory disease (+18.7%; 95% CI, 6.2, 32.6). Inflation-adjusted costs increased in psychiatric/behavioral diseases and substance abuse (+10.6%; 95% CI, 8.2, 12.9), systemic states (+9.5%; 95% CI, 3.9, 15.3), and endocrine/metabolic/nutritional diseases (+6.3%; 95% CI, 0.7, 12.3). Post-pandemic cost increase was greatest for ENT/dental/mouth disease (+24.6%; 95% CI, 16.9, 32.7), eye disease (+24.1%; 95% CI, 15.3, 33.6), and psychiatric/behavioral diseases and substance abuse (+12.1%; 95% CI, 5.1, 19.6).

We identified changes in ED presentations and costs over time, with notable changes for psychiatric/behavioral and substance abuse conditions. These findings have implications for health systems and policymakers amid major shifts in ED use over the past decade.