title: Patient- and Community-Level Sociodemographic Characteristics Associated with Emergency Department Visits for Childhood Injury.
abstract: OBJECTIVE
  To examine pediatric emergency department (ED) visits over 5 years, trends in injury severity, and associations between injury-related ED visit outcome and patient and community-level sociodemographic characteristics.
  
  
  METHODS
  Retrospective analysis of administrative data provided to the Pediatric Emergency Care Applied Research Network Core Data Project, 2004-2008. Home addresses were geocoded to determine census block group and associated sociodemographic characteristics. Maximum Abbreviated Injury Scale severity and Severity Classification System scores were calculated. Generalized estimating equations were used to test for associations between sociodemographic characteristics and admission or transfer among injury-related ED visits.
  
  
  RESULTS
  Overall ED visits and injury-related visits increased from 2004 to 2008 at study sites. Of 2,833676 successfully geocoded visits, 700,821 (24.7%) were injury-related. The proportion of higher severity injury-related visits remained consistent. Nearly 10% of injury-related visits resulted in admission or transfer each year. After adjusting for age, sex, payer, and injury severity, odds of admission or transfer were lower among minority children and children from areas with moderate and high prevalence of poverty.
  
  
  CONCLUSIONS
  Pediatric injury-related ED visits to included sites increased over the study period while injury severity, anticipated resource utilization, and visit outcomes remained stable, with low rates of admission or transfer. Sociodemographic differences in injury-related visits and ED disposition were apparent. ED-based injury surveillance is essential to understand disparities, inform targets for prevention programs, and reduce the overall burden of childhood injuries.
authors.affiliation: Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI; University of Michigan Injury Center, Ann Arbor, MI; Division of General Pediatrics, Child Health Evaluation and Research (CHEAR) Unit, University of Michigan Medical School, Ann Arbor, MI. Electronic address: mlmacy@umich.edu.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Macy
authors.affiliation: Division of Emergency Medicine, Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Zonfrillo
authors.affiliation: Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Cook
authors.affiliation: Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Funai
authors.affiliation: University of Michigan Injury Center, Ann Arbor, MI.
authors.forename: Jason
authors.initials: J
authors.lastname: Goldstick
authors.affiliation: Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Stanley
authors.affiliation: Division of Emergency Medicine, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC.
authors.forename: James M
authors.initials: JM
authors.lastname: Chamberlain
authors.affiliation: Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI; University of Michigan Injury Center, Ann Arbor, MI; Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Cunningham
authors.affiliation: Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI; University of Michigan Injury Center, Ann Arbor, MI.
authors.forename: Robert
authors.initials: R
authors.lastname: Lipton
authors.affiliation: Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Alpern
mesh_terms: D015998:Abbreviated Injury Scale; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007348:Insurance, Health; D008297:Male; D017057:Medically Uninsured; D008913:Minority Groups; D010343:Patient Admission / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000706:statistics & numerical data; D011203:Poverty; D044469:Racial Groups / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology*