title: Medical complexity and pediatric emergency department and inpatient utilization.
abstract: OBJECTIVE
  To characterize the use of and disposition from a tertiary pediatric emergency department (PED) by children with chronic conditions with varying degrees of medical complexity.
  
  
  METHODS
  We conducted a retrospective cohort study using a dataset of all registered PED patient visits at Seattle Children's Hospital from January 1, 2008, through December 31, 2009. Children's medical complexity was classified by using a validated algorithm (Clinical Risk Group software) into nonchronic and chronic conditions: episodic chronic, lifelong chronic, progressive chronic, and malignancy. Outcomes included PED length of stay (LOS) and disposition. Logistic regression generated age-adjusted odds ratios (AOR) of admission with 95% confidence intervals (CIs).
  
  
  RESULTS
  PED visits totaled 77 748; 20% (15 433) of which were for children with chronic conditions. Compared with visits for children without chronic conditions, those for children with chronic conditions had increased PED LOS (on average, 79 minutes longer; 95% CI 77-81; P < .0001) and hospital (51% vs 10%) and PICU (3.2% vs 0.1%) admission rates (AOR 10.3, 95% CI 9.9-10.7 to hospital and AOR 25.0, 95% CI 17.0-36.0 to PICU). Admission rates and PED LOS increased with increasing medical complexity.
  
  
  CONCLUSIONS
  Children with chronic conditions comprise a significant portion of annual PED visits in a tertiary pediatric center; medical complexity is associated with increased PED LOS and hospital or PICU admission. Clinical Risk Group may have utility in identifying high utilizers of PED resources and help support the development of interventions to facilitate optimal PED management, such as pre-arrival identification and individual emergency care plans.
authors: Emergency Services, Seattle Children's Hospital, 4800 Sand Point Way NE, B-5506, Seattle, WA, USA. lila.omahony@seattlechildrens.org
authors: Lila
authors: L
authors: O'Mahony
authors: D Shane
authors: DS
authors: O'Mahony
authors: Tamara D
authors: TD
authors: Simon
authors: John
authors: J
authors: Neff
authors: Eileen J
authors: EJ
authors: Klein
authors: Linda
authors: L
authors: Quan
mesh_terms: D000293:Adolescent; D000465:Algorithms; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D015331:Cohort Studies; D003299:Cooperative Behavior; D057286:Electronic Health Records / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D033183:Interdisciplinary Communication; D038801:International Classification of Diseases; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010348:Patient Care Team / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012984:Software; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*; D014600:Utilization Review / Q000706:statistics & numerical data; D014861:Washington; D055815:Young Adult