Descriptive Analysis of Pediatric Emergency Department Use at the Virginia Commonwealth University Health System (1996-2000)

Kulsoom Razvi

Advisor: William Nelson, M.D., M.P.H.

Preceptor: Elizabeth P. Eustis-Turf, Ph.D.

OBJECTIVE: With more than one-third of emergency department (ED) visits being for non-urgent reasons, hospitals are often overwhelmed by patients seeking primary care needs in the emergency room setting. The main objective of this study is to describe the population of patients visiting the Pediatric Emergency Department (PED) of the Virginia Commonwealth University Health System (VCUHS) and to identify the top four medical reasons for PED use. In turn, this data will be used to assess whether patients are using the ED for primary care.

METHODS: Diagnosis codes were obtained from billing data for each patient visit to the PED, from fiscal years 1996-2000. These codes were classified into 1 of 17 categories, in accordance with the International Classification for Diseases, 9th Revision (ICD-9 CM). In addition, such variables as age, race, gender, insurance status, and patient type (emergency only vs. inpatient), were also reviewed. In order to determine the physical location from which patients come, county data on each patient was also obtained. 

RESULTS: Age, race, gender, patient type, and county of residence were found to be consistent across the five years of study. The top four diagnostic categories were also found to be fairly constant across the five years, with “Injury and Poisoning” and “Diseases of the Respiratory System” always occupying the first and second highest frequencies, respectively. The third and fourth most frequent categories varied but consisted of the following groups: “Infectious and Parasitic Diseases,” “Symptoms, Signs, and Ill-Defined Conditions,” and “Diseases of the Nervous System and Sense Organs”. In addition, more than 89% of PED visits resulted in discharge and less than 11% were admitted for hospitalization, from the PED.

CONCLUSIONS: As expected for a Level I Trauma Center, injury-related visits account for the most frequent reasons for PED use. However, non-urgent visits to the VCUHS PED were for such diagnoses as eye/ear infections and upper respiratory tract infections, which could potentially be addressed in a primary care setting. By increasing access to primary care as well as addressing public perception of ED use, the number of non-urgent visits to the VCUHS PED may decline.