title: Variation in resource utilization across a national sample of pediatric emergency departments.
abstract: OBJECTIVE
  To describe variations in emergency department (ED) quality measures and determine the association between ED costs and outcomes for 3 pediatric conditions: asthma, gastroenteritis, and simple febrile seizure.
  
  
  METHODS
  This cross-sectional analysis of ED visits used the Pediatric Health Information System database. Children aged ≤ 18 years who were evaluated in an ED between July 2009 and June 2011 and had a discharge diagnosis of asthma, gastroenteritis, or simple febrile seizure were included. Two quality of care metrics were evaluated for each target condition, and Spearman correlation was applied to evaluate the relationship between ED costs (reflecting overall resource utilization) and admission and revisit rates among institutions.
  
  
  RESULTS
  More than 250,000 ED visits at 21 member hospitals were analyzed. Among children with asthma, the median rate of chest radiography utilization was 35.1% (IQR, 31.3%-41.7%), and that of corticosteroid administration was 82.6% (IQR, 78.5%-86.5%). For children with gastroenteritis, the median rate of ondansetron administration was 52% (IQR, 43.2%-57.0%), and that of intravenous fluid administration was 18.1% (IQR, 15.3%-21.3%). Among children with febrile seizures, the median rate of computed tomography utilization was 3.1% (IQR, 2.7%-4.3%), and that of lumbar puncture was 4.0% (IQR, 2.3%-5.6%). Increased costs were not associated with lower admission rate or 3-day ED revisit rate for the 3 conditions.
  
  
  CONCLUSIONS
  We observed variation in quality measures for patients presenting to pediatric EDs with common conditions. Higher costs were not associated with lower hospitalization or ED revisit rates.
authors: Department of Pediatric Emergency Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA. Anupam.kharbanda@childrensmn.org
authors: Anupam B
authors: AB
authors: Kharbanda
authors: Matthew
authors: M
authors: Hall
authors: Samir S
authors: SS
authors: Shah
authors: Stephen B
authors: SB
authors: Freedman
authors: Rakesh D
authors: RD
authors: Mistry
authors: Charles G
authors: CG
authors: Macias
authors: Bema
authors: B
authors: Bonsu
authors: Peter S
authors: PS
authors: Dayan
authors: Evaline A
authors: EA
authors: Alessandrini
authors: Mark I
authors: MI
authors: Neuman
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000191:economics* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D005759:Gastroenteritis / Q000191:economics* / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D003294:Seizures, Febrile / Q000191:economics* / Q000628:therapy*; D014481:United States