Annual report on health care for children and youth in the United States: focus on injury-related emergency department utilization and expenditures.
ABSTRACT 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.
[Show abstract] [Hide abstract]
ABSTRACT: The purpose of this retrospective study was to determine the outcomes of traumatized teeth treated in a pediatric emergency department. The records of pediatric patients presenting to the pediatric emergency department of a pediatric hospital over a 56-month period were reviewed and pertinent data were extracted. Treatment outcomes and contributing factors were analyzed for cases with greater than 6 months of follow up. A total of 264 patient records (548 traumatized teeth) were investigated. The mean age of the children was 8.2 years and 62% were boys. The most common ages for dental trauma were between 2-4 years and 8-10 years. Permanent dentition comprised 53% of the traumatized teeth. Extrusive and lateral luxations (29.5%) were the most common injuries encountered. Two hundred and thirty seven teeth (43%) presented for follow-up visits, and the mean duration of follow up was 55.6 days. The number of cases with more than 6 months of follow up decreased to 122 (22%). Of these, 31 (6%) teeth were extracted at the time of injury. Outcomes were ascertained for the remaining 91 (17%) teeth. Emergency dental treatment led to uncomplicated retention of teeth beyond 6 months in 58% of these cases. Luxation injuries had a higher success rate than avulsions (P = 0.046). After receiving emergency dental care in the emergency department, 43% of the teeth presented for follow-up dental care and only 22% were followed up for greater than 6 months. Emergency department treatment translated to successful retention of teeth in 58% of the cases with documented follow up. Severe periodontal injuries resulted in treatment complications. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.Dental Traumatology 11/2014; 31(2). DOI:10.1111/edt.12148 · 1.21 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Background. Integrating age appropriate injury prevention messages during a well-child visit is challenging in the face of competing demands. Purpose. To describe a 7-month pilot using technology to facilitate injury prevention risk assessment and education integration. Methods. We prospectively tracked responses to the computer-based injury prevention self-assessment tool, safety product distribution, and any subsequent contact with the local hospital system for related unintentional injuries. Results. A total of 2091 eligible visits by 1368 unique patients were assessed. Eight hundred forty-three unique patients completed the Safe N' Sound assessment and 7 were subsequently injured, with an injury related to a Safe N' Sound target area. Conclusions. A kiosk-based tailored injury assessment tool can be successfully integrated into a busy pediatric practice. Unintentional injury outcomes can be linked to the tailored anticipatory guidance and can identify the effectiveness of this electronic integration of injury prevention messaging into well-child examinations.Clinical Pediatrics 09/2014; 53(14). DOI:10.1177/0009922814549544 · 1.26 Impact Factor