Title

Variation in Hospitalization Rates Following Emergency Department Visits in Children with Medical Complexity.

Document Type

Article

Publication Date

11-2019

Identifier

DOI: 10.1016/j.jpeds.2019.07.034

Abstract

OBJECTIVES: To evaluate factors associated with admission from emergency department (ED) encounters for children with medical complexity (CMC) and to quantify the hospital admission rate as well as variation in adjusted hospital admission rates across EDs.

STUDY DESIGN: Retrospective study of 271 806 visits to 37 EDs in freestanding children's hospitals from January 1, 2014, to June 30, 2017, for patients of all ages with a complex chronic condition. Associations between patient demographic, clinical, and health services characteristics and the likelihood of hospital admission were identified using generalized linear models, which were then used to calculate adjusted hospital admission rates.

RESULTS: Hospital admission occurred with 25.7% of ED visits. Characteristics with the greatest aOR of hospitalization were ≥3 compared with 0 prior hospitalizations in 365 days (4.7; 95% CI, 4.5-4.9), ED arrival overnight compared with during workday 3.2 (95% CI, 3.1-3.3)], and ≥6 vs 0-1 chronic conditions (1.6; 95% CI, 1.5-1.6). Adjusted hospital admission rates varied significantly (P < .001) across EDs (21.1% [10th percentile]) and 30.0% [90th percentile]). Significant variation remained when excluding low-intensity ED visits, excluding hospitalizations requiring surgery and/or intensive care, or restricting the cohort to overnight ED arrival and to children with ≥3 prior hospitalizations.

CONCLUSIONS: CMC are frequently admitted from the ED. Substantial variation in CMC hospital admission rates across EDs exists after case-mix adjustment.

Journal Title

The Journal of pediatrics

Volume

214

First Page

113

Last Page

120

MeSH Keywords

Adolescent; Child; Child, Preschool; Chronic Disease; Emergency Service, Hospital; Female; Hospitalization; Hospitals, Pediatric; Humans; Infant; Infant, Newborn; Linear Models; Male; Multimorbidity; Retrospective Studies; United States; Young Adult

Keywords

children with medical complexity; emergency department; hospitalization

Comments

Erratum in

  • Corrigendum. J Pediatr. 2020 Mar;218:e1. doi: 10.1016/j.jpeds.2019.10.079. Epub 2019 Dec 5.PMID: 31813534

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