Emergency department visits for gastrointestinal bleeding in children: results from the Nationwide Emergency Department Sample 2006-2011

Abstract

Objective: To describe the epidemiology and trends in pediatric gastrointestinal (GI) bleeding associated emergency department (ED) visits in the US.

Methods: Estimates of GI bleeding associated ED visits were calculated in children from birth to 19 years of age using the Nationwide Emergency Department Sample (NEDS).

Results: From 2006 to 2011, there were an estimated total of 437,283 ED visits associated with diagnosis of GI bleeding. Specifically, there were 88,675 cases of upper GI bleeding, 132,102 cases of lower GI bleeding and 217,008 cases of unspecified GI bleeding. GI bleeding associated ED visits increased from 82.2/100,000 children in 2006 to 93.9/100,000 children in 2011 (14.3% increase; P < 0.01). The rate of increase was chiefly noted for lower GI bleeding (31.3%) followed by unspecified GI bleeding (10.4%) with a relatively minor increase in upper GI bleeding (1.1%). The greatest number of visits occurred in children 15-19 years of age (39.2%). A majority of patients underwent routine discharge (80.8%). Risk factors independently associated with an increased rate of hospital admission included ≥3 comorbid conditions (adjusted odds ratio [aOR] 112.2; 95% CI 103.4-121.7), presentation to a teaching hospital (aOR 3.2; 95% CI 3.1-3.2), the presence of upper GI bleeding (aOR 3.1; 95% 3.0-3.2), health coverage with private insurance (aOR 1.6; 95% CI 1.6-1.7) and children <5 years of age (aOR 1.3; 95% CI 1.2-1.3).

Conclusion: Our results indicate that there has been an increasing incidence of GI bleeding associated ED visits in children from 2006 to 2011 with cases of lower GI bleeding accounting for the largest increase. Only a small number of children merited admission to the hospital, suggesting that a majority of visits involved non-life-threatening bleeds. These data represent important complementary information to the overall study of pediatric GI bleeding in the US.

Keywords: Children; GI bleeding; National Emergency Department Sample; Pediatric.