EMERGENCY DEPARTMENT UTILIZATION BY ADOLESCENTS

Purpose: To review adolescents' utilization of a hospital emergency de partment (ED) in a rural area, to identify their characteristics, and to explore their motivation to seek health care in this setting. Metho ds: A retrospective chart survey of all 4932 adolescent visits (ages 1 2-18 years, 55.5% females) to the ED in a small town with a population of 55,000 serving a rural area was conducted for the calendar year 19 89. Chief complaints and diagnoses were retrospectively categorized ac cording to six groups: injury, pulmonary problems, Ob/Gyn, infection, nonspecific pain (complaint)/ no diagnosis (diagnoses), and ''other.'' Results: There was an increasing number of visits with increasing age . Adolescents with private insurance, who accounted for 50% of patient s, were more likely than self-paying adolescents (14%) and adolescents on Medicaid (36%) to have a primary care source and to have access to a telephone. Injury was the most common diagnosis with motor vehicle accidents (MVA) accounting for 15% of all injuries. Self-paying adoles cents and those on Medicaid were more likely to be diagnosed with an i nfection or an Ob/Gyn problem than adolescents with health insurance. Only 5.9% of adolescents were admitted to the hospital service. 8.5% o f adolescents were discharged from the ED without a diagnosis. 78% of these had complained about nonspecific pain. Conclusions: Many adolesc ents in this rural area were found not to have an identified primary c are source and to seek health care in EDs. Illnesses that could have b een prevented or treated in a more cost-effective setting thus become ''emergencies.'' Primary care sources are needed that are accessible a nd acceptable to adolescents.