Author + information
- Received April 13, 2018
- Revision received June 15, 2018
- Accepted July 12, 2018
- Published online October 1, 2018.
- Jonathan B. Edelson, MDa,∗ (, )@JEdelsonMD@ChildrensPhila,
- Joseph W. Rossano, MD, MSa,
- Heather Griffis, PhDb,
- Dingwei Dai, PhDb,
- Jennifer Faerber, PhDb,
- Chitra Ravishankar, MDa,
- Christopher E. Mascio, MDc,
- Laura M. Mercer-Rosa, MD, MSCEa,
- Andrew C. Glatz, MD, MSCEa and
- Kimberly Y. Lin, MDa
- aDepartment of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- bHealthcare Analytics Unit, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- cDepartment of Pediatrics, Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- ↵∗Address for correspondence:
Dr. Jonathan B. Edelson, Division of Cardiology, The Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Suite 8NW90, Philadelphia, Pennsylvania 19104.
Background Data related to the epidemiology and resource utilization of congenital heart disease (CHD)–related emergency department (ED) visits in the pediatric population is limited.
Objectives The purpose of this analysis was to describe national estimates of pediatric CHD-related ED visits and evaluate medical complexity, admissions, resource utilization, and mortality.
Methods This was an epidemiological analysis of ED visit-level data from the 2006 to 2014 Nationwide Emergency Department Sample. Patients age <18 years with CHD were identified using International Classification of Diseases-9th Revision-Clinical Modification codes. We evaluated time trends using weighted regression and tested the hypothesis that medical complexity, resource utilization, and mortality are higher in CHD patients.
Results A total of 420,452 CHD-related ED visits (95% confidence interval [CI]: 416,897 to 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 to 1.93), higher median ED charges ($1,266 [interquartile range (IQR): $701 to $2,093] vs. $741 [IQR: $401 to $1,332]), and a higher mortality rate (1% vs. 0.04%; adjusted odds ratio: 1.25; 95% CI: 1.07 to 1.45). Adjusted median charges for CHD-related ED visits increased from $1,219 (IQR: $673 to $2,138) to $1,630 (IQR: $901 to $2,799), while the mortality rate decreased from 1.13% (95% CI: 0.71% to 1.52%) to 0.75% (95% CI: 0.41% to 1.09%) over the 9 years studied.
Conclusions 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. Over 9 years, charges increased, but the mortality rate improved.
Dr. Rossano has served as a consultant for Novartis and Amgen. Dr. Mascio has served as a consultant to and received honoraria from HeartWare. Dr. Mercer-Rosa has received support from National Institutes of Health grant NIH K01HL125521, and from the Pulmonary Hypertension Society. Dr. Lin has served as a consultant for Pfizer. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 13, 2018.
- Revision received June 15, 2018.
- Accepted July 12, 2018.
- 2018 American College of Cardiology Foundation
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