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Why pediatric patients with cancer visit the emergency department: United States, 2006–2010
Author(s) -
Mueller Emily L.,
Sabbatini Amber,
Gebremariam Achamyeleh,
Mody Rajen,
Sung Lillian,
Macy Michelle L.
Publication year - 2015
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.25288
Subject(s) - medicine , emergency department , confidence interval , odds ratio , pediatric cancer , retrospective cohort study , cancer , neutropenia , emergency medicine , cohort , medical diagnosis , logistic regression , pediatrics , toxicity , pathology , psychiatry
Background Little is known about emergency department (ED) use among pediatric patients with cancer. We explored reasons prompting ED visits and factors associated with hospital admission. Procedure A retrospective cohort analysis of pediatric ED visits from 2006 to 2010 using the Nationwide Emergency Department Sample, the largest all‐payer database of United States ED visits. Pediatric patients with cancer (ages ≤19 years) were identified using Clinical Classification Software. Proportion of visits and disposition for the top ten‐ranking non‐cancer diagnoses were determined. Weighted multivariate logistic regression was performed to analyze factors associated with admission versus discharge. Results There were 294,289 ED visits by pediatric patients with cancer in the U.S. over the study period. Fever and fever with neutropenia (FN) were the two most common diagnoses, accounting for almost 20% of visits. Forty‐four percent of pediatric patients with cancer were admitted to the same hospital, with admission rates up to 82% for FN. Risk factors for admission were: FN (odds ratio (OR) 8.58; 95% confidence interval (CI) 5.97–12.34); neutropenia alone (OR 7.28; 95% CI 5.08–10.43), ages 0–4 years compared with 15–19 years (OR 1.19; 95% CI 1.08–1.31) and highest median household income ZIP code (OR 1.27; 95% CI 1.08–1.49) compared with lowest. “Self‐pay” visits had lower odds of admission (OR 0.42; 95% CI 0.35–0.51) compared with public payer. Conclusion FN was the most common reason for ED visits among pediatric patients with cancer and is the condition most strongly associated with admission. Socioeconomic factors appear to influence ED disposition for this population. Pediatr Blood Cancer 2015;62:490–495. © 2014 Wiley Periodicals, Inc.