title: Characteristics of Children With Cancer Discharged or Admitted From the Emergency Department.
abstract: BACKGROUND
  Emergency department (ED) utilization by children with cancer is poorly understood. Among children with cancer, we explored reasons for ED visits and factors associated with admission within U.S. children's hospitals.
  
  
  METHODS
  A retrospective study of the 2011-2013 Pediatric Health Information System (PHIS) was conducted. Eligible ED visits included those within 365 days from the first inpatient encounter with an International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) code for cancer. Patient characteristics and reasons for ED visits were assessed. Factors associated with admission from the ED were examined with multivariable regression.
  
  
  RESULTS
  There were 26,770 ED visits by 17,943 children with cancer at 39 children's hospitals during the study period. Half of children with cancer visited the ED within 1 year after their first cancer hospitalization in PHIS. Fifty-six percent of ED visits resulted in admission. Fever or neutropenia accounted for the largest proportion of reasons for visits (34.6%). Risk factors for admission were as follows: "Other" race/ethnicity as compared to white, non-Hispanic (odds ratio [OR] = 1.4, 95% confidence interval [CI] 1.2-1.6), history of transplant (OR = 1.7, 95% CI 1.4-2.1), and ED visits reasons including neutropenia (OR = 43.4, 95% CI 36.0-52.3), blood stream infection (OR = 3.3, 95% CI 2.8-3.9), pancytopenia (OR = 28.8, 95% CI 18.1-45.9), dehydration (OR = 2.3, 95% CI 1.9-2.9), or pneumonia (OR = 3.8, 95% CI 2.8-5.1).
  
  
  CONCLUSIONS
  Children with cancer have high ED usage within 1 year after their first cancer hospitalization. Age, demographic factors, and reasons for ED visits significantly impacted admission from the ED. Further research should focus on ED utilization among children with cancer.
authors.affiliation: Section of Pediatric Hematology Oncology, Department of Pediatrics, Indiana University, Indianapolis, Indiana.|Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, Indianapolis, Indiana.
authors.forename: Emily L
authors.initials: EL
authors.lastname: Mueller
authors.affiliation: Children's Hospital Association, Overland Park, Kansas.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hall
authors.affiliation: Division of Hospital Medicine, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.affiliation: Section of Pediatric Hematology/Oncology/Stem Cell Transplantation, University of Missouri, Kansas City, Missouri.
authors.forename: Keith J
authors.initials: KJ
authors.lastname: August
authors.affiliation: Section of Pediatric Hematology/Oncology/Stem Cell Transplantation, University of Missouri, Kansas City, Missouri.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Radhi
authors.affiliation: Child, Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan.|Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Macy
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000628:therapy*; D010343:Patient Admission; D010351:Patient Discharge; D012189:Retrospective Studies
keywords: adolescent; child; febrile neutropenia; oncology; supportive care