title: Why pediatric patients with cancer visit the emergency department: United States, 2006-2010.
abstract: BACKGROUND
  Little is known about emergency department (ED) use among pediatric patients with cancer. We explored reasons prompting ED visits and factors associated with hospital admission.
  
  
  METHODS
  A retrospective cohort analysis of pediatric ED visits from 2006 to 2010 using the Nationwide Emergency Department Sample, the largest all-payer database of United States ED visits. Pediatric patients with cancer (ages ≤19 years) were identified using Clinical Classification Software. Proportion of visits and disposition for the top ten-ranking non-cancer diagnoses were determined. Weighted multivariate logistic regression was performed to analyze factors associated with admission versus discharge.
  
  
  RESULTS
  There were 294,289 ED visits by pediatric patients with cancer in the U.S. over the study period. Fever and fever with neutropenia (FN) were the two most common diagnoses, accounting for almost 20% of visits. Forty-four percent of pediatric patients with cancer were admitted to the same hospital, with admission rates up to 82% for FN. Risk factors for admission were: FN (odds ratio (OR) 8.58; 95% confidence interval (CI) 5.97-12.34); neutropenia alone (OR 7.28; 95% CI 5.08-10.43), ages 0-4 years compared with 15-19 years (OR 1.19; 95% CI 1.08-1.31) and highest median household income ZIP code (OR 1.27; 95% CI 1.08-1.49) compared with lowest. "Self-pay" visits had lower odds of admission (OR 0.42; 95% CI 0.35-0.51) compared with public payer.
  
  
  CONCLUSIONS
  FN was the most common reason for ED visits among pediatric patients with cancer and is the condition most strongly associated with admission. Socioeconomic factors appear to influence ED disposition for this population.
authors.affiliation: Department of Pediatrics and Communicable Diseases, Division of Pediatric Hematology Oncology, University of Michigan, Ann Arbor, Michigan; Department of Pediatrics and Communicable Diseases, Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, Michigan.
authors.forename: Emily L
authors.initials: EL
authors.lastname: Mueller
authors.forename: Amber
authors.initials: A
authors.lastname: Sabbatini
authors.forename: Achamyeleh
authors.initials: A
authors.lastname: Gebremariam
authors.forename: Rajen
authors.initials: R
authors.lastname: Mody
authors.forename: Lillian
authors.initials: L
authors.lastname: Sung
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Macy
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D064147:Febrile Neutropenia / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008954:Models, Biological; D009369:Neoplasms / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D012984:Software; D014481:United States
keywords: United States; emergency service; febrile neutropenia; health care surveys; oncology; supportive care