Common and costly conditions among children in United States Emergency Departments

To identify the most common and costly diagnoses among children presenting to US emergency departments (EDs) and to assess whether the distribution of these diagnoses and the associated resource utilization, including costs, vary according to hospital type.

We conducted a retrospective cross-sectional study of children (<18 years) using the 2023 Nationwide Emergency Department Sample. We categorized the principal diagnoses using the Diagnosis Grouping System. We estimated costs by applying hospital-specific cost-to-charge ratios to ED charges. We identified the most common and costly DGS subgroups, overall and by hospital urbanicity and teaching status.

We identified 23,956,458 encounters. Most children were seen at metropolitan teaching EDs (55.6%), with smaller percentages seen at pediatric EDs (14.8%), metropolitan non-teaching EDs (14.8%), and non-metropolitan EDs (14.9%). The most common diagnosis subgroups were viral illnesses (6.6%), infectious nose and sinus disorders (6.5%), infectious respiratory diseases (6.2%), lacerations, amputations, and uninfected foreign bodies (5.3%), and infectious mouth and throat disorders (5.2%). Pediatric EDs encountered relatively more medical conditions, whereas non-metropolitan and metropolitan non-teaching hospitals had higher rankings for infectious mouth and throat disorders, strains and sprains, and abdominal pain. Total care costs were $10.4B. Costliest conditions were infectious respiratory diseases ($0.6B), fractures and dislocations ($0.6B), viral illnesses ($0.6B), abdominal pain ($0.5B), and psychiatric and behavioral diseases ($0.5B).

Common and costly pediatric ED diagnoses are dominated by infectious and respiratory conditions, with variation in case mix and resource utilization across hospital types. These findings have implications for pediatric readiness and low-value care initiatives.