title: Urgency of emergency department visits by children with sickle cell disease: a comparison of 3 chronic conditions.
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.
authors.affiliation: Department of Pediatrics, Division of Quality and Safety, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. dbundy@jhmi.edu
authors.forename: David G
authors.initials: DG
authors.lastname: Bundy
authors.forename: John J
authors.initials: JJ
authors.lastname: Strouse
authors.forename: James F
authors.initials: JF
authors.lastname: Casella
authors.forename: Marlene R
authors.initials: MR
authors.lastname: Miller
mesh_terms: D000367:Age Factors; D000755:Anemia, Sickle Cell / Q000503:physiopathology / Q000628:therapy*; D001249:Asthma / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D002673:Child, Hospitalized / Q000706:statistics & numerical data; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology / Q000628:therapy*; D018450:Disease Progression; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004638:Emergency Treatment / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D016015:Logistic Models; D008297:Male; D008396:Maryland; D015999:Multivariate Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors