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Emergency Department Visits by Children With Congenital Heart Disease
Study Questions:
What are the national estimates of pediatric congenital heart disease (CHD)–related emergency department (ED) visits and their medical complexity, admissions, resource utilization, and mortality?
Methods:
The investigators performed an epidemiological analysis of ED visit-level data from the 2006 to 2014 Nationwide Emergency Department Sample. Patients ages <18 years with CHD were identified using International Classification of Diseases-9th Revision-Clinical Modification codes. The authors evaluated time trends using weighted regression and tested the hypothesis that medical complexity, resource utilization, and mortality are higher in CHD patients. National estimates of ED visit outcomes (hospital admission, mortality, total charges) were analyzed by year using weighted generalized linear regression.
Results:
A total of 420,452 CHD-related ED visits (95% confidence interval [CI], 416,897-422,443 visits) were identified, accounting for 0.17% of all pediatric ED visits. Those with CHD were more likely to be <1 year of age (43% vs. 13%), and to have ≥1 complex chronic condition (35% vs. 2%). CHD-related ED visits had higher rates of inpatient admission (46% vs. 4%; adjusted odds ratio, 1.89; 95% CI, 1.85-1.93), higher median ED charges ($1,266 [interquartile range (IQR), $701-$2,093] vs. $741 [IQR, $401-$1,332]), and a higher mortality rate (1% vs. 0.04%; adjusted odds ratio, 1.25; 95% CI, 1.07-1.45). Adjusted median charges for CHD-related ED visits increased from $1,219 (IQR, $673-$2,138) to $1,630 (IQR, $901-$2,799), while the mortality rate decreased from 1.13% (95% CI, 0.71%-1.52%) to 0.75% (95% CI, 0.41%-1.09%) over the 9 years studied.
Conclusions:
The authors concluded that children with CHD presenting to the ED represent a medically complex population at increased risk for morbidity, mortality, and resource utilization compared with those without CHD.
Perspective:
This study defines the burden of CHD, with >46,000 CHD ED visits per year and reports that infants (age <1 year) represent a substantial portion of CHD ED visits, with the risk of admission decreasing progressively with the age of the patient at the time of presentation. Furthermore, children with CHD presenting to the ED have higher resource utilization and mortality than those without CHD. These data highlight the demand that the CHD population places on EDs with respect to volume of visits, acuity of presentation, and resource consumption. Improved understanding of the causes of ED visits and mortality may help optimize resource utilization and improve outcomes for children with CHD presenting to the ED.
Keywords: Chronic Disease, Cost of Illness, Emergency Service, Hospital, Heart Defects, Congenital, Infant, Inpatients, Morbidity, Patient Admission, Pediatrics, Primary Prevention
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