Annual Report on Health Care for Children and Youth in the United States: Focus on Injury-Related Emergency Department Utilization and Expenditures

Agency for Healthcare, Research and Quality, Department of Health and Human Services, Rockville, Maryland 20850, USA.
Ambulatory Pediatrics (Impact Factor: 2.49). 07/2008; 8(4):219-240.e17. DOI: 10.1016/j.ambp.2008.03.032
Source: PubMed


To examine state differences in children's utilization of injury-related emergency department (ED) care across 14 states, benchmarking aggregate state estimates against national expenditure estimates for outpatient injury-related ED care.
A retrospective analysis was performed using the 2003 State Emergency Department Databases and State Inpatient Databases from the Healthcare Cost and Utilization Project and data from the Medical Expenditure Panel Survey. Pediatric ED visits with any injury International Classification of Diseases Ninth Version Clinical Modification (ICD-9-CM) diagnosis code were selected. The Barell Injury Diagnosis Matrix, ICDMAP-90 software, and the Trauma Information Exchange Program data were used to classify injuries, produce injury severity scores, and examine utilization in trauma centers. Aggregate and state-specific descriptive analyses compared differences in patient and injury characteristics and admission status by age, severity of injury, and expected payer.
Over 1.5 million or nearly one-third of ED visits were for pediatric injuries in the 14 states studied. Nationally, 5.4% of children had an injury-related ED visit, and approximately $2.3 billion was spent on outpatient injury-related ED visits in 2003. The pattern of injury-related ED visit care varied considerably by state. For example, injury-related ED visit rates ranged from 63.3 to 164.4 per 1000 children. Infants, adolescents, children from very low income communities, and children from nonmetropolitan and nonmicropolitan areas were more likely to have an injury-related ED visit than their peers. Although patient characteristics were fairly consistent across states, admission rates and expected source of payment for injury-related ED visits varied considerably by state. Hospital admission rates ranged from 1.5% to 4.4% of injury-related ED visits and expected payer estimates ranged from 37.1% to 71.0% of visits billed to private insurance, 17.9% to 47.0% billed to Medicaid, and 2.1% to 10.4% billed as uninsured.
This study suggests that injuries account for a significant portion of pediatric ED visits. There is substantial variation in ED use and hospital admissions for injured children across states and payers. This variation suggests that there are several opportunities for improvement in emergency care for children. To better understand the underlying reason for the variation, multivariate and hypothesis-driven research should focus on the nature and outcomes of injury-related ED care in the context of small area practice patterns and state programs, policies, and care system characteristics.

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    • "Injuries are the largest cause of morbidity and mortality among children in the United States and Canada, and are the leading cause of emergency department (ED) visits for children greater than 1 year of age [1-3]. Injury-related ED visits in the United States are estimated to range from 63 to 165 per 1,000 children [4]. The vast majority of pediatric injuries are treated acutely in EDs with a strong focus on physical trauma. "
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    ABSTRACT: Pediatric injury is highly prevalent and has significant impact both physically and emotionally. The majority of pediatric injuries are treated in emergency departments (EDs), where treatment of physical injuries is the main focus. In addition to physical trauma, children often experience significant psychological trauma, and the development of acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) is common. The consequences of failing to recognize and treat children with ASD and PTSD are significant and extend into adulthood. Currently, screening guidelines to identify children at risk for developing these stress disorders are not evident in the pediatric emergency setting. The goal of this systematic review is to summarize evidence on the psychometric properties, diagnostic accuracy, and clinical utility of screening tools that identify or predict PTSD secondary to physical injury in children. Specific research objectives are to: (1) identify, describe, and critically evaluate instruments available to screen for PTSD in children; (2) review and synthesize the test-performance characteristics of these tools; and (3) describe the clinical utility of these tools with focus on ED suitability. Computerized databases including MEDLINE, EMBASE, CINAHL, ISI Web of Science and PsycINFO will be searched in addition to conference proceedings, textbooks, and contact with experts. Search terms will include MeSH headings (post-traumatic stress or acute stress), (pediatric or children) and diagnosis. All articles will be screened by title/abstract and articles identified as potentially relevant will be retrieved in full text and assessed by two independent reviewers. Quality assessment will be determined using the QUADAS-2 tool. Screening tool characteristics, including type of instrument, number of items, administration time and training administrators level, will be extracted as well as gold standard diagnostic reference properties and any quantitative diagnostic data (specificity, positive and negative likelihood/odds ratios) where appropriate. Identifying screening tools to recognize children at risk of developing stress disorders following trauma is essential in guiding early treatment and minimizing long-term sequelae of childhood stress disorders. This review aims to identify such screening tools in efforts to improve routine stress disorder screening in the pediatric ED setting.Trials registration: PROSPERO registration: CRD42013004893.
    Systematic Reviews 03/2014; 3(1):19. DOI:10.1186/2046-4053-3-19
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    • "Among pediatric patients presenting for acute care at the A&E at KATH during the study period, the majority of children (n = 116, 66%) presented for injuries, and 43% (n = 50) of these injuries were road traffic injuries. In comparison, nearly one-third (32%) of pediatric Emergency Department visits in the US in 2003 were for injuries, of which 28% of patients presented for a fall and 7% presented for a motor vehicle-related injury [15]. "
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    ABSTRACT: Background According to the World Health Organization (WHO), injuries represent the largest cause of death among people ages 140 –and contribute to a large burden of disease worldwide. The aims of this study were to characterize the prevalence and relative mechanism of injury among children seeking emergency care and describe the demographics at time of presentation among these children to inform further research in Ghana and sub-Saharan Africa. Methods A prospective cross-sectional survey of pediatric patients (n = 176) was conducted between 13 July 2009 and 30 July 2009 in the Accident and Emergency Center at Komfo Anoche Teaching Hospital (KATH) in Kumasi, Ghana. Participants were asked questions regarding demographics, insurance status, overall health, and chief complaint. Results Of the 176 patients surveyed, 66% (n = 116) presented for injuries. The mean age was 4.7 years (range 1.5 months to 17 years), and 68% (n = 120) were male. Of those presenting with injury, 43% (n = 50) had road traffic injuries (RTI). Of the RTIs, 58% (n = 29) were due to being an occupant in a car crash, 26% (n = 13) were pedestrian injuries, and 14% (n = 7) were from motorcycles. There was no significant difference in demographics, health status or indicators of socioeconomic status between injured and non-injured patients. Conclusions Among pediatric patients presenting for acute care at KATH during the study time frame, the majority (n = 116, 66%) presented for injuries. To date, there are no studies that characterize pediatric patients that present for acute care in Ghana. Identifying injury patterns and collecting epidemiologic data are important to guide future research and educational initiatives for Emergency Medicine.
    International Journal of Emergency Medicine 09/2012; 5(1):36. DOI:10.1186/1865-1380-5-36
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