National Patterns of Pediatric Emergency Department Utilization by Arrival Mode and Geographic Setting: Final Data from the National Hospital Ambulatory Medical Care Survey 2016–2022

OBJECTIVES: To characterize national patterns of pediatric emergency department (ED) utilization from 2016 through 2022, with emphasis on emergency medical services (EMS) arrival, metropolitan status, and temporal changes in diagnostic composition. METHODS: Revision (ICD-10) groupings. RESULTS: From 2016 through 2022, an estimated 202.5 million pediatric ED visits occurred, representing approximately 22% of all ED encounters. Of these, 9.0 million visits (4.4%) arrived by EMS after exclusion of interfacility transfers. Children comprised approximately 7% of EMS transports nationally. Compared with non-EMS arrivals, EMS-arriving children were more likely to be triaged as high acuity (29.8% vs 8.5%), to require hospital admission or transfer (24.9% vs 5.3%), and to have at least one abnormal vital sign (40.4% vs 22.6%). Injury and respiratory diseases were amongst the most common diagnostic categories for ED encounters overall. Psychiatric, behavioral, and substance use-related conditions accounted for approximately 12% of pediatric EMS encounters and increased over the study period. Although rural EDs cared for fewer pediatric visits overall, rates of abnormal vital signs were similar between urban and rural settings. Pediatric ED volume declined in 2020 and subsequently rebounded. CONCLUSIONS: Children accounted for approximately one-fifth of ED visits but only about 1 in 14 EMS transports. Pediatric EMS encounters were disproportionately high acuity and included an increasing proportion of psychiatric and behavioral conditions. Rural EDs encountered similar physiologic severity despite lower pediatric volume. These patterns underscore the low-frequency but high-severity nature of pediatric EMS encounters and highlight considerations for pediatric readiness across both prehospital and hospital emergency care systems.