title: Frequent Emergency Department Utilizers Among Children with Cancer.
abstract: BACKGROUND
  Pediatric frequent emergency department (ED) utilizers contribute a significant proportion of ED visits, but no studies specifically address children with cancer.
  
  
  METHODS
  A retrospective study of Pediatric Health Information System analyzing ED visits for children with cancer, including ED visits within 365 days from the first inpatient encounter with a discharge diagnosis code for malignancy. We defined frequent ED utilizers as those with four or more visits in the year (top 10th percentile). Patient characteristics and ED services (medications, laboratory, or imaging) for discharged children were assessed. Factors associated with being a frequent ED utilizer were examined with multivariable regression.
  
  
  RESULTS
  Frequent utilizers accounted for 58% of ED visits. Frequent utilizers differed from infrequent utilizers in terms of type of cancer; 39.3% of frequent utilizers had acute lymphoblastic leukemia (ALL) and 16.0% had central nervous system (CNS) tumors compared with infrequent utilizers (21.9% had ALL and 24.8% CNS tumors, P-value < 0.001). Frequent utilization was associated with age 5-9 years (odds ratio [OR] = 1.4, 95% confidence interval [CI] 1.2-1.6) or 1-4 years (OR = 2.1, 95% CI 1.8-2.4) or <1 year (OR = 2.2, 95% CI 1.9-2.6) compared to 15-19 years and Hispanic ethnicity (OR 1.3, 95% CI 1.1-1.5) compared to white, non-Hispanics, and urban residence (OR = 1.5, 95% CI 1.3-1.7). Few children with cancer received no medication, laboratory, or imaging during their ED visit (frequent 11.0% vs. infrequent 12.5%, P = 0.01).
  
  
  CONCLUSIONS
  The ED is integral to the care provided to children with cancer. The subset of frequent utilizers should be the focus of future research and quality improvement efforts.
authors: Section of Pediatric Hematology Oncology, Department of Pediatrics, Indiana University, Indianapolis, Indiana.|Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, Indianapolis, Indiana.
authors: Emily L
authors: EL
authors: Mueller
authors: Children's Hospital Association, Overland Park, Kansas.
authors: Matt
authors: M
authors: Hall
authors: Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, Indianapolis, Indiana.|Center for Health Policy and Professionalism Research, Indiana University, Indianapolis, Indiana.
authors: Aaron E
authors: AE
authors: Carroll
authors: Division of Hospital Medicine, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio.
authors: Samir S
authors: SS
authors: Shah
authors: 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: Michelle L
authors: ML
authors: Macy
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000628:therapy*; D012189:Retrospective Studies; D014481:United States
keywords: adolescent; child; oncology; supportive care