Why pediatric patients with cancer visit the emergency department: United States, 2006–2010

Abstract

BACKGROUND Little is known about emergency department (ED) use among pediatric patients with cancer. We explored reasons prompting emergency department (ED) visits and factors associated with hospital admission. PROCEDURE A retrospective cohort analysis of pediatric ED visits from 2006-2010 using the Nationwide Emergency Department Sample, the largest all-payer database of United States ED visits. Pediatric patients with cancer (ages ≤19 years) were identified using Clinical Classification Software. Proportion of visits and disposition for the top ten-ranking non-cancer diagnoses were determined. Weighted multivariate logistic regression was performed to analyze factors associated with admission versus discharge. RESULTS There were 294,289 ED visits by pediatric patients with cancer in the US over the study period. Fever and fever with neutropenia (FN) were the two most common diagnoses, accounting for almost 20% of visits. Forty-four percent of pediatric patients with cancer were admitted to the same hospital, with admission rates up to 82% for FN. Risk factors for admission were: FN (odds ratio (OR) 8.58; 95% confidence interval (CI) 5.97-12.34); neutropenia alone (OR 7.28; 95% CI 5.08-10.43), ages 0-4 years compared with 15-19 years (OR 1.19; 95% CI 1.08-1.31) and highest median household income ZIP code (OR 1.27; 95% CI 1.08-1.49) compared with lowest. “Self-pay” visits had lower odds of admission (OR 0.42; 95% CI 0.35-0.51) compared with public payer. CONCLUSION FN was the most common reason for ED visits among pediatric patients with cancer and is the condition most strongly associated with admission. Socioeconomic factors appear to influence ED disposition for this population.

Relationship between Insurance Type and Discharge Disposition From the Emergency Department of Young Children Diagnosed with Physical Abuse

“…3 Children with cancer who are self-pay are more likely to be discharged than those with public or private insurance. 4 Whether the primary drivers of disposition decisions in the above cases are analogous to those in cases of physical abuse is unknown.…”

“…4 However, less is known about how the association between insurance type and disposition extends to the vulnerable population of young abused children. Children younger than 2 years of age account for approximately one-fifth of cases of child maltreatment and over 60% of child fatalities from abuse.…”

CONCERN for Cancer

“…It's patterned on a similar analysis of pediatric patients that was published in late 2014. 1 That study found that fever and febrile neutropenia were the most common diagnoses in the ED, accounting for about 20% of visits, and up to 82% of the patients with febrile neutropenia ended up being admitted to the hospital.…”

Use of patient registries and administrative datasets for the study of pediatric cancer

“…This group used a multistep process for stratifying cancer-related admissions into four categories: chemotherapy-related, procedure-related, infection-related, or toxicity-related. Similarly, Mueller et al described the use of CCS to describe the reasons for emergency department visits among pediatric cancer patients, including risk factors for admission to the hospital [34]. …”