Urgency of emergency department visits by children with sickle cell disease: A comparison of 3 chronic conditions

David G. Bundy, John Strouse, James F Casella, Marlene R. Miller

Research output: Contribution to journalArticle

Abstract

Objective: Children with sickle cell disease (SCD) often receive care in the emergency department (ED), but the urgency of these frequent visits is not well understood. This study examined ED use by children with SCD by comparing the urgency of ED visits among children with SCD, asthma, and diabetes mellitus. Methods: We conducted a retrospective cohort study of Maryland ED visits for SCD, diabetes, or asthma from 2000 to 2004. ED visits resulting in hospital admission were deemed urgent. The urgency of ED visits not resulting in admission was determined using 2 methodologies: evaluation and management (E/M) coding and resource utilization. Multivariable logistic regression models were used to compare the likelihood of admission or urgent, treat-and-release ED visits across the 3 chronic conditions. Results: Nearly half (45%) of ED visits with a primary diagnosis of SCD resulted in admission, which was substantially higher than the 12% seen for asthma (adjusted odds ratio [AOR] 6.9, 95% confidence interval [CI], 6.4-7.4) and comparable to that seen for diabetes (41%). ED visits associated with primary diagnoses of SCD (AOR 5.9, 95% CI, 5.3-6.5) and diabetes (AOR 6.6, 95% CI, 6.0-7.3) were more likely than those associated with asthma to result in either admission or a discharge of higher urgency, as measured by E/M coding. These relationships persisted among repeat ED visitors, for visits with any diagnosis (ie, primary or nonprimary) of SCD, diabetes, and asthma, and when evaluated using the resource utilization method. Conclusions: Similar to visits by children with diabetes, ED visits by children with SCD are substantially more likely than those by children with asthma to be of high urgency.

Original languageEnglish (US)
Pages (from-to)333-341
Number of pages9
JournalAcademic Pediatrics
Volume11
Issue number4
DOIs
StatePublished - Jul 2011

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Sickle Cell Anemia
Hospital Emergency Service
Asthma
Odds Ratio
Confidence Intervals
Logistic Models
Diabetes Mellitus
Cohort Studies
Retrospective Studies

Keywords

  • asthma
  • diabetes mellitus
  • hospital emergency service
  • hospitalization
  • sickle cell disease

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Urgency of emergency department visits by children with sickle cell disease : A comparison of 3 chronic conditions. / Bundy, David G.; Strouse, John; Casella, James F; Miller, Marlene R.

In: Academic Pediatrics, Vol. 11, No. 4, 07.2011, p. 333-341.

Research output: Contribution to journalArticle

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abstract = "Objective: Children with sickle cell disease (SCD) often receive care in the emergency department (ED), but the urgency of these frequent visits is not well understood. This study examined ED use by children with SCD by comparing the urgency of ED visits among children with SCD, asthma, and diabetes mellitus. Methods: We conducted a retrospective cohort study of Maryland ED visits for SCD, diabetes, or asthma from 2000 to 2004. ED visits resulting in hospital admission were deemed urgent. The urgency of ED visits not resulting in admission was determined using 2 methodologies: evaluation and management (E/M) coding and resource utilization. Multivariable logistic regression models were used to compare the likelihood of admission or urgent, treat-and-release ED visits across the 3 chronic conditions. Results: Nearly half (45{\%}) of ED visits with a primary diagnosis of SCD resulted in admission, which was substantially higher than the 12{\%} seen for asthma (adjusted odds ratio [AOR] 6.9, 95{\%} confidence interval [CI], 6.4-7.4) and comparable to that seen for diabetes (41{\%}). ED visits associated with primary diagnoses of SCD (AOR 5.9, 95{\%} CI, 5.3-6.5) and diabetes (AOR 6.6, 95{\%} CI, 6.0-7.3) were more likely than those associated with asthma to result in either admission or a discharge of higher urgency, as measured by E/M coding. These relationships persisted among repeat ED visitors, for visits with any diagnosis (ie, primary or nonprimary) of SCD, diabetes, and asthma, and when evaluated using the resource utilization method. Conclusions: Similar to visits by children with diabetes, ED visits by children with SCD are substantially more likely than those by children with asthma to be of high urgency.",
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