title: Characteristics of recurrent utilization in pediatric emergency departments.
abstract: OBJECTIVE
  Nationally, frequent utilizers of emergency departments (EDs) are targeted for quality improvement initiatives. The objective was to compare the characteristics and ED health services of children by their ED visit frequency.
  
  
  METHODS
  A retrospective study in 1,896,547 children aged 0 to 18 years with 3,263,330 visits to 37 EDs in 2011. The number of ED visits per child within 365 days of their first visit was counted. Patient characteristics (age, chronic condition) and ED care (medications, testing [laboratory and radiographic], and hospital admission) were assessed. We evaluated the relationship between patient characteristics and ED health services received with multivariable regression.
  
  
  RESULTS
  Children with ≥4 ED visits (8%) accounted for 24% of all visits and 31% ($1.4 billion) of all costs. As visit frequency increased from 1 to ≥4, the percentage of children aged <1 year increased (12.1% to 33.2%) and the percentage of children without a chronic condition decreased (81.9% to 45.6%) (P < .001 for both). Children with ≥4 ED visits had a higher percentage of visits without medication administration (aside from acetaminophen or ibuprofen), testing, or hospital admission when compared with children with 1 visit (35.4% vs 29.0%; P < .001). Children with ≥4 ED visits who were aged <1 year (odds ratio: 3.8; 95% confidence interval: 3.7-3.9) and who were without a chronic condition (odds ratio: 3.1; 95% confidence interval: 3.0-3.1) had the highest likelihood of experiencing this type of visit.
  
  
  CONCLUSIONS
  With a disproportionate share of pediatric ED cost and utilization, frequent utilizers, especially infants without a chronic condition, are the least likely to need medications, testing, and hospital admission.
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; mark.neuman@childrens.harvard.edu.
authors.forename: Mark I
authors.initials: MI
authors.lastname: Neuman
authors.affiliation: Division of Emergency Medicine, Lurie Children's Hospital, Center of Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois;
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Alpern
authors.affiliation: Children's Hospital Association, Overland Park, Kansas;
authors.forename: Matt
authors.initials: M
authors.lastname: Hall
authors.affiliation: Division of Pediatric Emergency Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota;
authors.forename: Anupam B
authors.initials: AB
authors.lastname: Kharbanda
authors.affiliation: Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio;
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.affiliation: Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children's Hospital and Research Institute, University of Calgary, Calgary, Alberta, Canada;
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Freedman
authors.affiliation: Section of Emergency Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut;
authors.forename: Paul L
authors.initials: PL
authors.lastname: Aronson
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio;
authors.forename: Todd A
authors.initials: TA
authors.lastname: Florin
authors.affiliation: Section of Emergency Medicine, Department of Pediatrics, Children's Hospital of Colorado, Denver, Colorado; and.
authors.forename: Rakesh D
authors.initials: RD
authors.lastname: Mistry
authors.affiliation: Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Jay G
authors.initials: JG
authors.lastname: Berry
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D010342:Patient Acceptance of Health Care; D010372:Pediatrics / Q000639:trends*; D012189:Retrospective Studies
keywords: emergency department; frequency; utilization