EMERGENCY DEPARTMENT UTILIZATION BY ADOLESCENTS IN THE UNITED-STATES

Background. Adolescents in the United States have been shown to underu tilize primary care services and therefore may rely heavily on emergen cy service. Although several small studies have explored local emergen cy services for youth, there are no published reports of adolescent ut ilization of emergency services on a national scale. Furthermore, emer gency services data have not been aggregated according to the age subg roups used by the current guidelines for adolescent care. Objective. T o explore the utilization of emergency departments in the United State s by early (11 to 14 years), middle (15 to 17 years), and late (18 to 21 years) adolescent subgroups. Design. Secondary analysis of the emer gency department component of the 1994 National Hospital Ambulatory Me dical Care Survey. Setting. Nationally representative sample of 418 em ergency departments in the United States. Patients. Approximately 26 5 47 visits by patients of all ages, representing 93.4 million total vis its in 1994 and 14.8 million adolescent visits. Outcome Measures. Numb er of visits, health insurance, reasons for visits, urgency of visits, resulting diagnoses, and hospitalization rates. Results. Adolescents accounted for 15.4% of the population and 15.8% of emergency departmen t visits in 1994. Late adolescents were overrepresented in emergency d epartment visits relative to their population proportion (6.8% of visi ts, 5.3% of population), whereas early adolescents were underrepresent ed (4.6% of visits, 5.9% of population). Lack of health insurance was more common among II-to 21-year-olds (26.2%) than either children (13. 6%) or adults (22.7%). By ages 18 to 21 years, 40.5% of male visits an d 27.6% of female visits were uninsured. Injury-related visits were mo re common among adolescents (28.6%) than either children (23.1%) or ad ults (18.2%). Injury was the leading reason for visits among all adole scent age-sex subgroups (36.6% to 42.0% of male visits and 14.1% to 27 .2% of female visits) except females aged 18 to 21 years for whom dige stive reasons ranked first (18.8%). Injury was the leading diagnosis f or all adolescent age-sex subgroups, with peaks at early adolescence o f 61.6% for males and 45.8% for females. Across all adolescent age-sex subgroups, 3.1% to 5.3% of visits resulted in hospitalization, and 41 .0% to 52.5% of visits were urgent. These rates did not differ from th ose of children but were lower than those of adults. Conclusions. Util ization of emergency departments increases and health insurance decrea ses during adolescence, suggesting that adolescents with inadequate he alth insurance may rely heavily on emergency departments for their hea lth care needs. Most adolescent visits to emergency departments are no t urgent and might be better treated through nonemergency, primary car e sites.