The Care of Adult Patients in Pediatric Emergency Departments

Margaret Samuels-Kalow; Mark I. Neuman; Jonathan Rodean; Jennifer R. Marin; Paul L. Aronson; Matthew Hall; Stephen B. Freedman; Rustin B. Morse; Eyal Cohen; Harold K. Simon; Samir S. Shah; Elizabeth R. Alpern

doi:10.1016/j.acap.2019.03.004

The Care of Adult Patients in Pediatric Emergency Departments

Margaret Samuels-Kalow^*, Mark I. Neuman, Jonathan Rodean, Jennifer R. Marin, Paul L. Aronson, Matthew Hall, Stephen B. Freedman, Rustin B. Morse, Eyal Cohen, Harold K. Simon, Samir S. Shah, Elizabeth R. Alpern

^*Corresponding author for this work

Pediatrics

Research output: Contribution to journal › Article › peer-review

9 Scopus citations

Abstract

Objective: Adult patients are increasingly receiving care in pediatric emergency departments (PEDs), but little is known about the epidemiology of these visits. The goals of this study were to examine the characteristics of adult patients (≥21 years) treated in PEDs and to describe the variation in resource utilization across centers. Methods: We conducted a cross-sectional study examining visits to 30 PEDs (2012–2016) using the Pediatric Health Information System. Visits were categorized using All Patient Refined Diagnosis Related Groups and compared between age cohorts. We used multivariable logistic models to examine variation in demographics, utilization, testing, treatment, and disposition. Results: There were 12,958,626 visits to the 30 PEDs over 5 years; 70,636 (0.6%) were by adults. Compared with children, adult patients had more laboratory testing (49% vs 34%), diagnostic imaging (32% vs 29%), and procedures (48% vs 31%), and they were more often admitted (17% vs 11%) or transferred (21% vs 0.7%) (P < .001 for all). In multivariable analysis, older age, black race, Hispanic ethnicity, and private insurance were associated with decreased odds of admission in adults seen in PEDs. Across PEDs, the admission rates (7%–25%) and transfer rates (6%–46%) for adults varied. Conclusions: Adult patients cared for at PEDs have higher rates of testing, diagnostic imaging, procedures, and admission or transfer. There is wide variation in the care of adults in PEDs, highlighting the importance of further work to identify the optimal approach to adults who present for care in pediatric centers.

Original language	English (US)
Pages (from-to)	942-947
Number of pages	6
Journal	Academic Pediatrics
Volume	19
Issue number	8
DOIs	https://doi.org/10.1016/j.acap.2019.03.004
State	Published - Nov 1 2019

Funding

This work was presented at the annual meetings of the Society for Academic Emergency Medicine (May 15–18, 2018; Indianapolis, Ind) and Pediatric Academic Societies (May 5–8, 2018; Toronto, Canada). Authorship statement: M.S.-K. and E.R.A. conceptualized the study; assisted with the design, analysis, and interpretation of the data; and drafted the manuscript. J.R. and M.H. provided statistical expertise. M.I.N. M.H. and J.R. contributed to the design of the study. M.I.N. J.R. J.R.M. P.L.A. M.H. S.B.F. R.B.M. E.C. H.K.S. and S.S.S. participated in interpretation of the data and critical revision of the manuscript. Financial disclosure: P.L.A. is supported by Clinical and Translational Science Awards grant number KL2 TR001862 from the National Center for Advancing Translational Science, a component of the National Institutes of Health. S.B.F. is supported by the Alberta Children's Hospital Professorship in Child Health and Wellness. There was no external funding for this manuscript. Financial disclosure: P.L.A. is supported by Clinical and Translational Science Awards grant number KL2 TR001862 from the National Center for Advancing Translational Science, a component of the National Institutes of Health. S.B.F. is supported by the Alberta Children's Hospital Professorship in Child Health and Wellness. There was no external funding for this manuscript.

Keywords

adult patients
pediatric emergency medicine
transitions in care

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health

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10.1016/j.acap.2019.03.004

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title = "The Care of Adult Patients in Pediatric Emergency Departments",

abstract = "Objective: Adult patients are increasingly receiving care in pediatric emergency departments (PEDs), but little is known about the epidemiology of these visits. The goals of this study were to examine the characteristics of adult patients (≥21 years) treated in PEDs and to describe the variation in resource utilization across centers. Methods: We conducted a cross-sectional study examining visits to 30 PEDs (2012–2016) using the Pediatric Health Information System. Visits were categorized using All Patient Refined Diagnosis Related Groups and compared between age cohorts. We used multivariable logistic models to examine variation in demographics, utilization, testing, treatment, and disposition. Results: There were 12,958,626 visits to the 30 PEDs over 5 years; 70,636 (0.6%) were by adults. Compared with children, adult patients had more laboratory testing (49% vs 34%), diagnostic imaging (32% vs 29%), and procedures (48% vs 31%), and they were more often admitted (17% vs 11%) or transferred (21% vs 0.7%) (P < .001 for all). In multivariable analysis, older age, black race, Hispanic ethnicity, and private insurance were associated with decreased odds of admission in adults seen in PEDs. Across PEDs, the admission rates (7%–25%) and transfer rates (6%–46%) for adults varied. Conclusions: Adult patients cared for at PEDs have higher rates of testing, diagnostic imaging, procedures, and admission or transfer. There is wide variation in the care of adults in PEDs, highlighting the importance of further work to identify the optimal approach to adults who present for care in pediatric centers.",

keywords = "adult patients, pediatric emergency medicine, transitions in care",

author = "Margaret Samuels-Kalow and Neuman, {Mark I.} and Jonathan Rodean and Marin, {Jennifer R.} and Aronson, {Paul L.} and Matthew Hall and Freedman, {Stephen B.} and Morse, {Rustin B.} and Eyal Cohen and Simon, {Harold K.} and Shah, {Samir S.} and Alpern, {Elizabeth R.}",

note = "Publisher Copyright: {\textcopyright} 2019 Academic Pediatric Association",

year = "2019",

month = nov,

day = "1",

doi = "10.1016/j.acap.2019.03.004",

language = "English (US)",

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T1 - The Care of Adult Patients in Pediatric Emergency Departments

AU - Samuels-Kalow, Margaret

AU - Neuman, Mark I.

AU - Rodean, Jonathan

AU - Marin, Jennifer R.

AU - Aronson, Paul L.

AU - Hall, Matthew

AU - Freedman, Stephen B.

AU - Morse, Rustin B.

AU - Cohen, Eyal

AU - Simon, Harold K.

AU - Shah, Samir S.

AU - Alpern, Elizabeth R.

PY - 2019/11/1

Y1 - 2019/11/1

N2 - Objective: Adult patients are increasingly receiving care in pediatric emergency departments (PEDs), but little is known about the epidemiology of these visits. The goals of this study were to examine the characteristics of adult patients (≥21 years) treated in PEDs and to describe the variation in resource utilization across centers. Methods: We conducted a cross-sectional study examining visits to 30 PEDs (2012–2016) using the Pediatric Health Information System. Visits were categorized using All Patient Refined Diagnosis Related Groups and compared between age cohorts. We used multivariable logistic models to examine variation in demographics, utilization, testing, treatment, and disposition. Results: There were 12,958,626 visits to the 30 PEDs over 5 years; 70,636 (0.6%) were by adults. Compared with children, adult patients had more laboratory testing (49% vs 34%), diagnostic imaging (32% vs 29%), and procedures (48% vs 31%), and they were more often admitted (17% vs 11%) or transferred (21% vs 0.7%) (P < .001 for all). In multivariable analysis, older age, black race, Hispanic ethnicity, and private insurance were associated with decreased odds of admission in adults seen in PEDs. Across PEDs, the admission rates (7%–25%) and transfer rates (6%–46%) for adults varied. Conclusions: Adult patients cared for at PEDs have higher rates of testing, diagnostic imaging, procedures, and admission or transfer. There is wide variation in the care of adults in PEDs, highlighting the importance of further work to identify the optimal approach to adults who present for care in pediatric centers.

AB - Objective: Adult patients are increasingly receiving care in pediatric emergency departments (PEDs), but little is known about the epidemiology of these visits. The goals of this study were to examine the characteristics of adult patients (≥21 years) treated in PEDs and to describe the variation in resource utilization across centers. Methods: We conducted a cross-sectional study examining visits to 30 PEDs (2012–2016) using the Pediatric Health Information System. Visits were categorized using All Patient Refined Diagnosis Related Groups and compared between age cohorts. We used multivariable logistic models to examine variation in demographics, utilization, testing, treatment, and disposition. Results: There were 12,958,626 visits to the 30 PEDs over 5 years; 70,636 (0.6%) were by adults. Compared with children, adult patients had more laboratory testing (49% vs 34%), diagnostic imaging (32% vs 29%), and procedures (48% vs 31%), and they were more often admitted (17% vs 11%) or transferred (21% vs 0.7%) (P < .001 for all). In multivariable analysis, older age, black race, Hispanic ethnicity, and private insurance were associated with decreased odds of admission in adults seen in PEDs. Across PEDs, the admission rates (7%–25%) and transfer rates (6%–46%) for adults varied. Conclusions: Adult patients cared for at PEDs have higher rates of testing, diagnostic imaging, procedures, and admission or transfer. There is wide variation in the care of adults in PEDs, highlighting the importance of further work to identify the optimal approach to adults who present for care in pediatric centers.

KW - adult patients

KW - pediatric emergency medicine

KW - transitions in care

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JO - Academic Pediatrics

JF - Academic Pediatrics

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ER -

The Care of Adult Patients in Pediatric Emergency Departments

Abstract

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Keywords

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