title: Infectious Disease-related Emergency Department Visits Among Children in the US.
abstract: BACKGROUND
  Although most research on infectious diseases (IDs) has focused on hospitalizations, this provides an incomplete picture of healthcare utilization. We describe the burden and epidemiologic features of ID-related emergency department (ED) visits among U.S. children.
  
  
  METHODS
  We conducted a cross-sectional analysis of the Nationwide Emergency Department Sample, a nationally representative sample of ED patients. We identified children who presented to the ED with a primary diagnosis of ID. Outcome measures were ID-related ED visits, hospitalizations through the ED and ED charges.
  
  
  RESULTS
  During 2011, we identified 1,914,509 ID-related ED visits among U.S. children, corresponding to a weighted estimate of 8,524,357 ED visits. This accounted for 28% of all ED visits by children. The frequency of ID-related ED visits was 10,290 visits per 100,000 children. The most common diagnoses were upper respiratory infection (41%), otitis media (18%) and lower respiratory infection (14%). Overall, 62% of ID-related ED visits were made by children with Medicaid; 35% were by those in the lowest income quartile. Among the ID-related ED visits, 424,725 (5%) resulted in hospitalization, with 513 hospitalizations per 100,000 children. The most common reason for hospitalization was lower respiratory infection, which accounted for 40% of all ID-related hospitalizations from the ED. Median charge per ED visit was $718, with total annual charges of $9.6 billion.
  
  
  CONCLUSIONS
  The public health burden of IDs, as measured by ED visits, subsequent hospitalizations and associated charges, was substantial. We also found that children with markers of lower socioeconomic status comprised a disproportionately high proportion of ID-related ED visits.
authors: From the *Department of Emergency Medicine, Massachusetts General Hospital; †Harvard Medical School, Boston, MA; and ‡Harvard Interfaculty Initiative in Health Policy, Cambridge, MA.
authors: Kohei
authors: K
authors: Hasegawa
authors: Yusuke
authors: Y
authors: Tsugawa
authors: Ari
authors: A
authors: Cohen
authors: Carlos A
authors: CA
authors: Camargo
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003141:Communicable Diseases / Q000175:diagnosis* / Q000473:pathology*; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult