Comparing definitions of a pediatric emergency department

Objective: Health services research on the differences in care between pediatric and general emergency departments (EDs) is limited by ambiguity regarding the definition of a pediatric ED. Our goal was to determine the proportion of EDs captured by commonly used definitions of pediatric ED. Methods: We linked data for 2016 from two databases from New York State – the State Emergency Department Database and State Inpatient Database (SEDD/SID) and the National Emergency Department Inventory-USA (NEDI-USA). We examined the following 4 common definitions of pediatric ED: (1) admission capability, (2) physically distinct pediatric area in the ED, (3) membership in the Children's Hospital Association, and (4) volume of pediatric ED visits (patients <18 years). We calculated the proportion of EDs that would be defined as pediatric for each criterion. We also examined the differences in patient demographics among pediatric EDs based on each criterion. Results: A total of 160 New York EDs were included in the linked databases. Across the 4 criteria, the proportion of EDs meeting the definition of pediatric ranged from 0% to 86%. Of the EDs, 86% had pediatric admission capability, 27%–38% had a physically distinct pediatric ED, and 8% were members of the Children's Hospital Association. No hospitals met the SEDD/SID criterion of ≥70% visits for patients <18 years. Discussion: The number of EDs and characteristics of patients seen varied widely based on the criterion used to define pediatric ED. Database linkage may make it challenging to identify pediatric hospitals in administrative data sets. A valid, standard definition of pediatric ED is critically needed to advance health services research.