Methods: We conducted a retrospective analysis of the 2011–2014 Nationwide Emergency Department Sample (NEDS) for ED visits made by patients 0–21 years with neurologic complex chronic conditions (neuro CCC). We compared patient, hospital, and ED visits characteristics between GEDs and PEDs using descriptive statistics. We assessed outcomes of admission, transfer, critical procedure performance, and mortality using multivariable logistic regression.

Results: There were 387,813 neuro CCC ED visits (0.3% of 0–21-year-old ED visits) in our sample. Care occurred predominantly in GEDs, and visits were associated with a high severity of illness (30.1%highest severity classification score). Compared to GED visits, PED neuro CCC visits were comprised of individuals who were younger, more likely to have comorbid conditions (32.9% vs 21%, P < 0.001), and technology assistance (65.4% vs. 45.9%) but underwent fewer procedures and had lower ED charges ($2,200 vs $1,520, P < 0.001). Visits to PEDs had lower adjusted odds of critical procedures (adjusted odds ratio [aOR] 0.74, 95% confidence interval [CI] 0.62–0.87), transfers (aOR 0.14, 95% CI 0.04–0.56), and mortality (aOR 0.38, 95% CI 0.19–0.75) compared to GEDs.

Conclusion: Care for children with neuro CCCs in a pediatric ED is associated with less resource utilization and lower rates of transfer and mortality. Identifying features of PED care for neuro CCCs could lead to lower costs and mortality for this population.

ABSTRACT

Introduction

This study aimed to assess the prevalence of risk behaviors and the impact of electronic risk behavior screening with personalized feedback among adolescents seeking care in the emergency department (ED).

Methods

Randomized control trial of tablet-based screening and feedback among adolescents presenting to the ED. Intervention youth received screening with individualized feedback. Control youth completed risk behavior screening only. All participants received 3-month online follow up surveys re-assessing health behaviors.

Results

296 subjects were enrolled and randomized. Approximately half were female (52.4%) and half white (54.4%) with a mean age of 15.4 years. The response rate at 3-month follow-up was 70.6%.  The most frequently reported risk behaviors were those negatively impacting long-term health: sleeping less than 8 hours per night (142/296=48%), drinking more than 2 sugary drinks per day (99/296=33.4%) and getting less than 3 days of physical activity per week (96/296=32.4%). The prevalence of high-risk behaviors with more immediate health consequences were depression (92/296 =31.1%); high alcohol (47/296=15.9%) or marijuana use (55/296=18.6%); texting when driving (41/296=13.8%) and inconsistent birth control or condom use (42/296=14.2%). There was no significant difference between groups in risk behavior changes from baseline to 3 months.

Conclusions

While risk behavior prevalence was high in this population, electronic personalized feedback alone was insufficient to induce change in behaviors. More research is warranted to understand the best strategies for reducing risk among youth presenting to the ED.

Background

Methods

Results

Conclusions

Background

Methods

Results

Conclusions