title: Prevalence of occult anemia in an urban pediatric emergency department: what is our response?
abstract: OBJECTIVE
  Treating or referring patients who are found to be anemic during pediatric emergency department (ED) encounters should lead to improved health in children and young adults. Before establishing guidelines how to approach the anemic in the pediatric ED, it is essential to determine the prevalence of anemia in the ED and our response to the presence of anemia.
  
  
  METHODS
  We performed a retrospective cross-sectional study on hemoglobin levels from patients 1 to 23 years evaluated in an inner-city public hospital pediatric ED during a 12-month period. The primary outcome measure was the prevalence of prior unknown or "occult" anemia, stratified by age, sex, and insurance status. The secondary outcome was the proportion of patients with "occult" anemia who had their condition diagnosed during their ED encounter. Descriptive data analysis was performed.
  
  
  RESULTS
  Our study population consisted of 2131 patients who had a complete blood count drawn in the ED. Prevalence of "occult" anemia was 13.9% (95% confidence interval [CI], 12.5%-15.4%). Proportions among the subpopulations were 14.8% (95% CI, 10.0%-19.5%) in preschool children, 16.3% (95% CI, 14.2%-18.3%) in females, 18.5% (95% CI, 15.4%-21.7%) in the uninsured, and 20.7% (95% CI, 16.5%-24.9%) in females of childbearing age without insurance. Only 24 patients (8%) with "occult" anemia had the condition identified on discharge.
  
  
  CONCLUSIONS
  Anemia has a high prevalence in this pediatric ED population, especially among females of childbearing age and the uninsured. Pediatric emergency medicine physicians are missing on an opportunity to address a common health problem that is easily corrected with appropriate therapy and outpatient follow-up.
authors.affiliation: Departments of Pediatrics and Emergency Medicine, New York University School of Medicine, New York, NY, USA. gkristinsson@gmail.com
authors.forename: George
authors.initials: G
authors.lastname: Kristinsson
authors.forename: Sarit
authors.initials: S
authors.lastname: Shtivelman
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hom
authors.forename: Michael G
authors.initials: MG
authors.lastname: Tunik
mesh_terms: D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000191:economics / Q000453:epidemiology* / Q000628:therapy; D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006779:Hospitals, Public; D006786:Hospitals, Urban; D006801:Humans; D007223:Infant; D019458:Insurance Coverage; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D055815:Young Adult