Hospital admissions of children from the emergency department: Are decisions regarding children on public assistance different?

Objective: To better understand the variables that influence the physician's decision to admit children from the emergency department (ED) for nonmedical problems. Methods: A multicenter prospective questionnaire survey over a three-month study period. For all admitted children, the emergency physician completed a survey which recorded demographic data, insurance status, primary care provider (PCP), admitting diagnoses, and reason for admission. The reason for admission was noted as strictly medical or nonmedical (either an illness that could have been managed on an ambulatory care basis or a 'psychosocial' admission). Group differences were analyzed by t test, χ², or logistic regression analysis where appropriate. Results: There were 4318 ED admissions at five institutions of which 185 (4%) were judged to be nonmedical. No age or gender differences were found between the medical and nonmedical admission populations. Using logistic regression, adjusted odds ratios for nonmedical admissions were as follows: Medicaid insurance (2.34, 95% CI = 1.61-3.41), clinic-based primary care provider (1.54, 95% CI = 1.06-2.23), no or unknown primary care provider (2.40, 95% CI = 1.52-3.78), and after hours leg, 5 PM to 8 AM] admissions (1.86, 95% CI = 1.31-2.63). Conclusions: These data suggest that children with lower socioeconomic status and limited primary care resources are more likely to be admitted from the ED for nonmedical reasons than children with commercial insurance resources or a private physician.