title: Emergency department utilization by adolescents in the United States.
abstract: BACKGROUND
  Adolescents in the United States have been shown to underutilize primary care services and therefore may rely heavily on emergency service. Although several small studies have explored local emergency services for youth, there are no published reports of adolescent utilization of emergency services on a national scale. Furthermore, emergency services data have not been aggregated according to the age subgroups used by the current guidelines for adolescent care.
  
  
  OBJECTIVE
  To explore the utilization of emergency departments in the United States by early (11 to 14 years), middle (15 to 17 years), and late (18 to 21 years) adolescent subgroups.
  
  
  METHODS
  Secondary analysis of the emergency department component of the 1994 National Hospital Ambulatory Medical Care Survey.
  
  
  METHODS
  Nationally representative sample of 418 emergency departments in the United States.
  
  
  METHODS
  Approximately 26,547 visits by patients of all ages, representing 93.4 million total visits in 1994 and 14.8 million adolescent visits.
  
  
  METHODS
  Number of visits, health insurance, reasons for visits, urgency of visits, resulting diagnoses, and hospitalization rates.
  
  
  RESULTS
  Adolescents accounted for 15.4% of the population and 15.8% of emergency department visits in 1994. Late adolescents were overrepresented in emergency department visits relative to their population proportion (6.8% of visits, 5.3% of population), whereas early adolescents were underrepresented (4.6% of visits, 5.9% of population). Lack of health insurance was more common among 11- to 21-year-olds (26.2%) than either children (13.6%) or adults (22.7%). By ages 18 to 21 years, 40.5% of male visits and 27.6% of female visits were uninsured. Injury-related visits were more common among adolescents (28.6%) than either children (23.1%) or adults (18.2%). Injury was the leading reason for visits among all adolescent age-sex subgroups (36.6% to 42.0% of male visits and 14.1% to 27.2% of female visits) except females aged 18 to 21 years for whom digestive reasons ranked first (18.8%). Injury was the leading diagnosis for all adolescent age-sex subgroups, with peaks at early adolescence of 61.6% for males and 45.8% for females. Across all adolescent age-sex subgroups, 3.1% to 5.3% of visits resulted in hospitalization, and 41.0% to 52.5% of visits were urgent. These rates did not differ from those of children but were lower than those of adults.
  
  
  CONCLUSIONS
  Utilization of emergency departments increases and health insurance decreases during adolescence, suggesting that adolescents with inadequate health insurance may rely heavily on emergency departments for their health care needs. Most adolescent visits to emergency departments are not urgent and might be better treated through nonemergency, primary care sites.
authors.affiliation: Craig-Dalsimer Program in Adolescent Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, USA.
authors.forename: A
authors.initials: A
authors.lastname: Ziv
authors.forename: J R
authors.initials: JR
authors.lastname: Boulet
authors.forename: G B
authors.initials: GB
authors.lastname: Slap
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D017678:Sex Distribution; D014481:United States; D014947:Wounds and Injuries / Q000453:epidemiology