Journal
PEDIATRICS
Volume 131, Issue 2, Pages E559-E565Publisher
AMER ACAD PEDIATRICS
DOI: 10.1542/peds.2012-1455
Keywords
children with special health care needs; medically complex; chronic conditions; children with chronic conditions
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Funding
- National Institute of Neurologic Disorders and Stroke [K23NS062900]
- Child Health Corporation of America via the Pediatric Research in Inpatient Setting Network Executive Council
- Seattle Children's Center for Clinical and Translational Research
- CTSA from the National Center for Research Resources, a component of the National Institutes of Health (NIH) [ULI RR025014]
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OBJECTIVES: To characterize the use of and disposition from a tertiary pediatric emergency department (PED) by children with chronic conditions with varying degrees of medical complexity. METHODS: We conducted a retrospective cohort study using a dataset of all registered PED patient visits at Seattle Children's Hospital from January 1, 2008, through December 31, 2009. Children's medical complexity was classified by using a validated algorithm (Clinical Risk Group software) into nonchronic and chronic conditions: episodic chronic, lifelong chronic, progressive chronic, and malignancy. Outcomes included PED length of stay (LOS) and disposition. Logistic regression generated age-adjusted odds ratios (AOR) of admission with 95% confidence intervals (CIs). RESULTS: PED visits totaled 77 748; 20% (15 433) of which were for children with chronic conditions. Compared with visits for children without chronic conditions, those for children with chronic conditions had increased PED LOS (on average, 79 minutes longer; 95% CI 77-81; P<.0001) and hospital (51% vs 10%) and PICU (3.2% vs 0.1%) admission rates (AOR 10.3, 95% CI 9.9-10.7 to hospital and AOR 25.0, 95% CI 17.0-36.0 to PICU). Admission rates and PED LOS increased with increasing medical complexity. CONCLUSIONS: Children with chronic conditions comprise a significant portion of annual PED visits in a tertiary pediatric center; medical complexity is associated with increased PED LOS and hospital or PICU admission. Clinical Risk Group may have utility in identifying high utilizers of PED resources and help support the development of interventions to facilitate optimal PED management, such as pre-arrival identification and individual emergency care plans. Pediatrics 2013; 131: e559-e565
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