title: Maternal and child factors affecting high-volume pediatric emergency department use.
abstract: OBJECTIVE
  To describe maternal and child characteristics associated with high-volume nonurgent pediatric emergency department (ED) use.
  
  
  METHODS
  We surveyed female caregivers of children aged 1 to 14 years who were brought to the ED at an urban medical center for nonurgent conditions. We analyzed characteristics associated with low-volume (1 ED visit) or high-volume (> or = 2 ED visits) use within the past year. Independent factors included predisposing, reinforcing, and enabling factors. Logistic regression was used to model high-volume ED use.
  
  
  RESULTS
  Of the 300 participants (84% response rate), 99 were low-volume users and 201 were high-volume users. Most participants were mothers (94%). In adjusted analyses, high-volume use was associated with caregivers being single [odds ratio (OR), 2.57; 95% confidence interval (CI), 1.13-5.80], having high-volume ED use for themselves (OR, 2.02; 95% CI, 1.08-3.80), seeking care primarily in the pediatric ED for "sick visits" (OR, 2.47; 95% CI, 1.12-5.49), and lack of weekend hours at their child's usual source of care (OR, 2.58; CI, 1.24-5.37).
  
  
  CONCLUSIONS
  Marital status, high maternal use of the ED, perception of the ED as the place to seek care for a sick child, and lack of weekend hours for usual source of care are associated with high-volume ED use among children. Given similarities in patterns of ED use among mothers and children, further attention is needed to address clinical practice and system issues that contribute to familial use of EDs.
authors.affiliation: Department of Pediatrics, Johns Hopkins University, Baltimore, MD 21287, USA. kzimmer1@jhmi.edu
authors.forename: Karen P
authors.initials: KP
authors.lastname: Zimmer
authors.forename: Allen R
authors.initials: AR
authors.lastname: Walker
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Minkovitz
mesh_terms: D000293:Adolescent; D000328:Adult; D039602:After-Hours Care / Q000706:statistics & numerical data; D017677:Age Distribution; D015142:Baltimore; D015984:Causality; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006304:Health Status; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D009035:Mothers / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D044469:Racial Groups / Q000706:statistics & numerical data; D012959:Socioeconomic Factors