CHARACTERISTICS OF FREQUENT PEDIATRIC EMERGENCY DEPARTMENT USERS

The purpose of this study was to examine the medical and demographic c haracteristics of patients who frequently seek emergency care at a ped iatric emergency department (ED). Registration information of ED visit s during the study period from 11/1/87 to 5/31/92 (4.6 years) was stor ed in a data base. Patients with 10 or more ED visits during this stud y period were considered to be ''frequent'' ED users. Outpatient and i npatient medical records of these patients were manually reviewed. Dem ographics, chronic conditions, and the acute conditions for each ED vi sit were coded and analyzed. During the study period, there were 79,04 9 ED patient visits under 21 years of age, Of the patients born after 1970, there were 47,451 visits by patients seen one or two times, 25,8 83 visits by patients seen three to nine times, and 5178 visits by 357 patients seen in the ED ten times or more. Ninety-nine patients were seen more than 15 times, 39 patients were seen more than 20 times, 17 patients were seen more than 25 times, and 10 patients were seen more than 30 rimes. Two hundred sixty-five of the 357 frequent ED users (74 %) had chronic disease conditions. Two hundred and twenty-three of the m had good functional status, 25 had mild or moderate impairment in ca rrying out activities of daily Living, and 17 had severe impairment of function. The most common chronic medical conditions were recurrent w heezing (226), neurologic conditions (33), gastrointestinal conditions (13), cardiac conditions (12), and endocrine conditions (9). The othe r 92 were assessed as healthy children. Patients' immunization status were up to date as of the last ED visit during the study period in 329 patients (92%). Pediatricians were the primary care providers in 339 patients (95%). Medical insurance status of patients follows: private insurance (38%), military (0.3%), Medicaid or state assistance (60%), and no insurance (1.4%). Polynesian ethnic groups were overrepresented in the cohort of frequent ED users. We conclude that cultural differe nces appeared to be an important factor associated with frequent ED us e by healthy persons, Medical care resources as measured by immunizati ons, insurance, and identification of a primary care physician did not appear to be deficient in this cohort of frequent ED users. Since rec urrent wheezing is a dominant chronic condition among frequent ED user s, pediatric emergency medicine training programs may consider the inc lusion of the chronic management of wheezing in their curriculum.