title: Recurrent and high-frequency use of the emergency department by pediatric patients.
abstract: OBJECTIVE
  The authors sought to describe the epidemiology of and risk factors for recurrent and high-frequency use of the emergency department (ED) by children.
  
  
  METHODS
  This was a retrospective cohort study using a database of children aged 0 to 17 years, inclusive, presenting to 22 EDs of the Pediatric Emergency Care Applied Research Network (PECARN) during 2007, with 12-month follow-up after each index visit. ED diagnoses for each visit were categorized as trauma, acute medical, or chronic medical conditions. Recurrent visits were defined as any repeat visit; high-frequency use was defined as four or more recurrent visits. Generalized estimating equations (GEEs) were used to measure the strength of associations between patient and visit characteristics and recurrent ED use.
  
  
  RESULTS
  A total of 695,188 unique children had at least one ED visit each in 2007, with 455,588 recurrent ED visits in the 12 months following the index visits. Sixty-four percent of patients had no recurrent visits, 20% had one, 8% had two, 4% had three, and 4% had four or more recurrent visits. Acute medical diagnoses accounted for most visits regardless of the number of recurrent visits. As the number of recurrent visits per patient rose, chronic diseases were increasingly represented, with asthma being the most common ED diagnosis. Trauma-related diagnoses were more common among patients without recurrent visits than among those with high-frequency recurrent visits (28% vs. 9%; p<0.001). High-frequency recurrent visits were more often within the highest severity score classifications. In multivariable analysis, recurrent visits were associated with younger age, black or Hispanic race or ethnicity, and public health insurance.
  
  
  CONCLUSIONS
  Risk factors for recurrent ED use by children include age, race and ethnicity, and insurance status. Although asthma plays an important role in recurrent ED use, acute illnesses account for the majority of recurrent ED visits.
authors.affiliation: The Department of Pediatrics, Northwestern University Feinberg School of Medicine, Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Alpern
authors.forename: Amy E
authors.initials: AE
authors.lastname: Clark
authors.forename: Evaline A
authors.initials: EA
authors.lastname: Alessandrini
authors.forename: Marc H
authors.initials: MH
authors.lastname: Gorelick
authors.forename: Marlena
authors.initials: M
authors.lastname: Kittick
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Stanley
authors.forename: J Michael
authors.initials: JM
authors.lastname: Dean
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Teach
authors.forename: James M
authors.initials: JM
authors.lastname: Chamberlain
mesh_terms: D000208:Acute Disease / Q000453:epidemiology / Q000628:therapy*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology / Q000628:therapy*