title: Complexity and Severity of Pediatric Patients Treated at United States Emergency Departments.
abstract: To compare the complexity and severity of presentation of children in general vs pediatric emergency departments (EDs).
  
  
  
  We performed a cross-sectional study of pediatric ED visits using the National Emergency Department Sample from 2008 to 2012. We classified EDs as "pediatric" if >75% of patients were <18 years old; all other EDs were classified as "general." The presence of an International Classification of Diseases, Ninth Revision code for a complex chronic condition was used as an indicator of patient complexity. Patient severity was evaluated with the severity classification system. In addition, rates of critical procedures and hospitalization were assessed.
  
  
  
  We identified 9.6 million encounters to pediatric EDs and 169 million to general EDs. Younger children account for a greater proportion of visits at pediatric EDs than general EDs; children <1 year of age account for 18% of visits to a pediatric ED compared with 9% of visits to a general ED (P < .01). Encounters at pediatric EDs had greater complexity (5% vs 2%; P < .01). Although severity classification system scores did not significantly differ by ED type, pediatric EDs had greater rates of hospitalization (10% vs 4%).
  
  
  
  Pediatric EDs provided care to a greater proportion of medically complex children than general EDs and had greater rates of hospitalization. This information may inform educational efforts in residency or postgraduate training to ensure high-quality care for children with complex health care needs.
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA. Electronic address: joel.hudgins@childrens.harvard.edu.
authors.forename: Joel D
authors.initials: JD
authors.lastname: Hudgins
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Monuteaux
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA.
authors.forename: Florence T
authors.initials: FT
authors.lastname: Bourgeois
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA.
authors.forename: Lise E
authors.initials: LE
authors.lastname: Nigrovic
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Fine
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA.
authors.forename: Lois K
authors.initials: LK
authors.lastname: Lee
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA.
authors.forename: Rebekah
authors.initials: R
authors.lastname: Mannix
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Lipsett
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA.
authors.forename: Mark I
authors.initials: MI
authors.lastname: Neuman
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology*
keywords: critical procedures; general EDs; pediatric EDs