Infectious Disease-related Emergency Department Visits Among Children in the US

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.