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Multicenter Study
. 2015 Sep;167(3):711-8.e1-4.
doi: 10.1016/j.jpeds.2015.05.047. Epub 2015 Jul 2.

Patient- And Community-Level Sociodemographic Characteristics Associated With Emergency Department Visits for Childhood Injury

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Multicenter Study

Patient- And Community-Level Sociodemographic Characteristics Associated With Emergency Department Visits for Childhood Injury

Michelle L Macy et al. J Pediatr. .
Free PMC article


Objective: To examine pediatric emergency department (ED) visits over 5 years, trends in injury severity, and associations between injury-related ED visit outcome and patient and community-level sociodemographic characteristics.

Study design: Retrospective analysis of administrative data provided to the Pediatric Emergency Care Applied Research Network Core Data Project, 2004-2008. Home addresses were geocoded to determine census block group and associated sociodemographic characteristics. Maximum Abbreviated Injury Scale severity and Severity Classification System scores were calculated. Generalized estimating equations were used to test for associations between sociodemographic characteristics and admission or transfer among injury-related ED visits.

Results: Overall ED visits and injury-related visits increased from 2004 to 2008 at study sites. Of 2,833676 successfully geocoded visits, 700,821 (24.7%) were injury-related. The proportion of higher severity injury-related visits remained consistent. Nearly 10% of injury-related visits resulted in admission or transfer each year. After adjusting for age, sex, payer, and injury severity, odds of admission or transfer were lower among minority children and children from areas with moderate and high prevalence of poverty.

Conclusions: Pediatric injury-related ED visits to included sites increased over the study period while injury severity, anticipated resource utilization, and visit outcomes remained stable, with low rates of admission or transfer. Sociodemographic differences in injury-related visits and ED disposition were apparent. ED-based injury surveillance is essential to understand disparities, inform targets for prevention programs, and reduce the overall burden of childhood injuries.

Conflict of interest statement

The authors declare no conflicts of interest.


Figure 1
Figure 1
Hospital and Visit Selection *Characteristics of Hospitals Included in Analysis, presented in order from highest to lowest number of ED visits in the study period
Hospital NumberFree-Standing Children’s HospitalLevel 1 Pediatric Trauma CenterTotal ED Visits; NED Visits for Injury n (%)ED Visits Resulting in Admission n (%)
1XX383,69487,964 (22.9)83,947 (21.9)
2XX356,35778,649 (22.1)57,093 (16.0)
3XX353,69990,719 (25.6)48,588 (13.7)
4XX274,06267,467 (24.6)38,040 (13.9)
5XX267,53545,216 (16.9)28,558 (10.7)
6XX206,35749,864 (24.2)49,919 (24.2)
7XX201,96453,394 (26.4)32,884 (16.3)
8X179,29551,599 (28.8)20,515 (11.4)
9X168,53936,718 (21.8)10,842 (6.4)
10127,33534,718 (27.3)22,214 (17.4)
11XX119,75226,187 (21.9)22,782 (19.0)
12108,22142,567 (39.3)6,409 (5.9)
13X101,43031,280 (30.8)17,236 (17.0)
14100,31827,215 (27.1)7,496 (7.5)
1584,92618,190 (21.4)6,878 (8.1)
16X57,73321,986 (38.1)13,207 (22.9)

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