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Children with chronic conditions in a pediatric emergency department
S Reynolds1, B Desguin, A Uyeda
1Division of Emergency Medicine, Children's Memorial Hospital, Northwestern University Medical School, Chicago, IL 60614, USA.
Insights
Children with chronic conditions represent 24% of pediatric emergency department (PED) visits, often occurring during off-hours. These children have higher admission rates, highlighting the critical role of PEDs.
Area of Science:
- Pediatrics
- Emergency Medicine
- Chronic Illness Management
Background:
- Pediatric emergency departments (PEDs) manage a diverse patient population.
- Understanding the specific needs of children with chronic conditions in PEDs is crucial for resource allocation and care optimization.
Purpose of the Study:
- To characterize the utilization patterns of a pediatric emergency department by children with chronic conditions.
- To identify the most frequent chronic conditions leading to PED visits and analyze admission rates.
Main Methods:
- Retrospective, descriptive study design.
- Analysis of 8561 patient visits to an urban tertiary care pediatric hospital's emergency department over three months.
- Categorization of visits based on patient's chronic condition status and demographic data.
Main Results:
- 24% of total visits (2024 out of 8561) were by children with chronic conditions.
- Asthma, neurology, hematology/oncology, neurosurgery, and cardiology were the most common chronic conditions.
- Children with chronic conditions had significantly higher admission rates (28%) compared to non-chronically ill children (11%) and higher intensive care unit admission rates (1% vs. 0.03%).
- 69% of visits by chronically ill children occurred during evenings, nights, or weekends.
Conclusions:
- Children with chronic conditions constitute a significant portion of pediatric emergency department usage.
- PEDs play a vital role in managing acute exacerbations of chronic conditions, often outside standard clinic hours.
- There is a need for PEDs to optimize systems for the efficient and effective care of pediatric patients with chronic illnesses.
Abstract:
The objective of this study was to describe the use of a pediatric emergency department (PED) by children with chronic conditions. The study design was retrospective and descriptive in an urban tertiary care pediatric hospital setting. We reviewed 8561 visits to a PED over a three-month time period. Two thousand twenty-four (24%) of the visits were by children with one or more chronic conditions. There were no interventions. The mean age of the patients was 4.9 years, and 61% were male. Thirty-one percent of the patients sought care between 8 AM and 5 PM Monday through Friday. Five subspecialty areas accounted for 86% of the chronic conditions seen: asthma (43%), neurology (15%), hematology/oncology (14%), neurosurgery (10%), and cardiology (4%). Twenty-eight percent of the chronically ill patients were admitted as compared to 11% of the nonchronically ill patients (P < 0.001). One percent of the chronically ill patients were admitted to the intensive care unit as compared to 0.03% of the nonchronically ill patients (P < 0.0001). It was concluded that children with chronic conditions account for one-quarter of all PED visits. Sixty-nine percent of those visits were made during evening/ nighttime hours or on the weekend. A relatively large percentage of these children were admitted. The pediatric emergency physicians provide an important service to both the children with chronic conditions and the subspecialists who care for them. PEDs may need to refine emergency department systems to serve this group of patients as efficiently and effectively as possible.