Urban emergency department utilization by adolescents

This study describes urban emergency department (ED) utilization and follow-up referral patterns among adolescents. ED visits for 14-19-year-old patients at an urban university hospital with adjacent adult and pediatric emergency departments during specified months in 1993 were retrospectively reviewed. A subgroup (n=150) was randomly selected for detailed chart review. One thousand six hundred and thirty-six adolescents were seen in the ED during the study period. Public assistance (n=763; 47%) and commercial insurance (n=480; 29%) were the most common forms of insurance, followed by self-pay (n=357; 22%). The majority of triage codes for ED visits were nonurgent (n=140; 93%). Twenty-five patients (17%) were not referred for follow-up upon ED discharge. Adolescents on public assistance or without insurance may frequently utilize an urban ED for nonurgent medical problems. A group of patients did not identify a primary care provider at triage and were not referred for follow-up. Defining medical problems for which adolescents utilize the ED may help health professionals to tailor community resources to better serve adolescent health care needs.     

Emergency department utilization by children in foster care.

OBJECTIVE: To examine emergency department (ED) utilization of children in foster care using nationally representative data. METHODS: Cross-sectional analysis of the National Survey of Child and Adolescent Well-Being, Wave 1, which provided data for children ages 1 to 14 years in foster care for 1 year between October 1999 and December 2000. We identified children as having used the ED based upon foster parent responses to the question, "In the last 12 months, has your child gone to an emergency room or urgent care center (UCC) for an illness or injury?" We examined child and family demographic variables that were associated with having used the ED. RESULTS: The sample included 559 children in foster care. Thirty-one percent (95% confidence interval = 26%, 36%) of foster children had visited the ED or UCC in the past 12 months. Multivariate logistic regression analysis revealed that out of all children in foster care, children who had a chronic condition, children of younger age, and children with younger foster caregivers were significantly more likely to have used the ED. CONCLUSION: A sizeable proportion of children in foster care use the ED, and subgroups of these children have particularly high rates of ED use. An important component of providing a medical home for children in foster care should involve coordination of care around ED visits for this vulnerable group of children.     

Emergency department utilization in pediatric heart transplant recipients

We used the NEDS database (2010) to evaluate ED utilization in PED HT recipients compared to other patient populations with focus on characteristics of ED visits, risk factors for admission, and charges. We analyzed 433 ED visits by PED HT recipients (median age 8 [range: 0‐18] years). The most common primary diagnosis category was infectious (n=163, 37.6%), with pneumonia being the most common infectious etiology. When compared to all PED visits, HT visits were more likely to result in hospital admission (32.6% versus 3.9%, P<.001), had greater hospital LOS (median of 3 days [IQR 2‐4] versus 2 days [IQR 1‐4], P=.001), and accumulated greater total hospital charges (median $26 317 [IQR $11 438‐$46 407] versus $12 332 [IQR $7092‐$22 583], P<.001). When compared to visits by other SOT recipients, results varied with similar rates of hospital admission for HT, LUNGT, and KT visits and similar LOS for HT and KT visits but differing total hospital charges. Although PED HT recipients account for a small percentage of overall ED visits, they are more likely to be hospitalized and require greater resource utilization compared to the general PED population, but not when compared to other SOT recipients.     

Use of indoor tanning facilities by white adolescents in the United States

CONTEXT: Indoor tanning is a risk factor for skin cancer, but the population-based prevalence of this behavior among adolescents is not clearly known. OBJECTIVES: To describe the prevalence of tanning booth use among white US adolescents and to assess its association with sociodemographic factors, health behaviors, and appearance. DESIGN, SETTING, AND PARTICIPANTS: A nationally representative sample of 6903 non-Hispanic white adolescents, aged 13 to 19 years, who participated in Wave II (between April 1, 1996, and August 31, 1996) of the National Longitudinal Study of Adolescent Health. MAIN OUTCOME MEASURE: Frequency of lifetime use of indoor artificial tanning facilities. RESULTS: With the data weighted to national levels, 36.8% of the white female adolescents and 11.2% of the white male adolescents have used a tanning booth at least once in their life, while 28.1% and 6.9% of the female and male adolescents, respectively, reported tanning booth use 3 or more times. The percentage of female adolescents using tanning booths 3 or more times increased with age, from 11.2% of the 13- to 14-year-olds to 47.0% of 18- to 19-year-olds and also increased with greater tanning ability, from 12.6% of the poor tanners to 38.1% of those with a strong tan response. After multivariate adjustment, those residing in the Midwest (adjusted odds ratio [aOR], 2.38; 95% confidence interval [CI], 1.53-3.68) or South (aOR, 2.91; 95% CI, 1.89-4.53), attending a rural high school (aOR, 1.80; 95% CI, 1.09-2.98), and reporting the use of 2 or 3 substances (aOR, 3.06; 95% CI, 2.44-3.82) were more likely to use indoor tanning facilities, as were dieters (aOR, 1.26; 95% CI, 1.01-1.57) regardless of their body mass index. Decreased odds of indoor tanning were observed among those with a college-educated mother (aOR, 0.68; 95% CI, 0.51-0.90) and greater cognitive ability (per 10-point score increase; aOR, 0.89; 95% CI, 0.82-0.96) while routine participation in physical activity significantly lowered the odds of indoor tanning only among female adolescents. CONCLUSIONS: Indoor tanning is prevalent, particularly among female adolescents, and aligns with other risk behaviors, appearance-related factors, and intentional sunbathing. The risks of artificial tanning need increased emphasis among adolescents, especially in the Midwest and South where extremes in the availability of natural light appear to send intentional tanners indoors.     

Health insurance status of adolescents in the United States

This analysis of a sample of 15,181 adolescents aged 10 to 18 years from the National Health Interview Survey indicates that 86% of adolescents had some form of private or public health care coverage during 1984. Nevertheless, one in every seven adolescents, or nearly 4.5 million nationwide, were without any form of health insurance coverage. Adolescents without insurance coverage were concentrated in poor and near-poor households, families with little formal education, and were more likely to live in the South or West. Minorities, especially Hispanic adolescents, were less likely than white adolescents to have some form of health insurance coverage, but much of this difference was attributable to the smaller incomes of minorities. Similarly, although adolescents living in single-parent households were less likely to be insured, the reduced likelihood of coverage appears to be primarily attributable to smaller family income in single-parent households. That family economics plays a central role in determining whether an adolescent had some form of coverage was confirmed by interview results concerning the major reasons for absence of coverage; 8 of 10 uninsured families cited economic reasons for absence of coverage. Together, these results indicate the principal barriers to obtaining health insurance are economic in nature. Public and private sector initiatives for reducing the size of the uninsured adolescent population are discussed.     

Emergency Care of Pediatric Asylum Seekers in the United States

There has been a significant increase in the number of asylum-seekers entering the United States in recent years, including children and unaccompanied minors. Upon arrival to the country, these young patients may seek care in an emergency department for acute medical issues related to their journey or chronic conditions that were undiagnosed or inadequately treated in their country of origin. The purpose of this article is to familiarize emergency department clinicians with the common medical conditions seen in pediatric asylum-seekers and outline the ethical and legal issues that may arise when caring for this vulnerable patient population.     

Bicycle-related injuries among children and adolescents in the United States

The objective of this study is to describe the epidemiology of bicycle-related injuries among children and adolescents 18 years and younger on a national level. This is a retrospective analysis of data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission for patients 18 years and younger who were seen in emergency departments (EDs) between January 1, 1990, and December 31, 2005, for injuries received while operating a bicycle. During the 16-year study period, there were an estimated 6 228 700 individuals 18 years and younger treated in US EDs for bicycle-related injuries. Children with head injuries were more than 3 (relative risk, 3.63) times as likely to require hospitalization and were almost 6 (relative risk, 5.77) times more likely to have their injuries result in death. The large number of annual bicycle related-injuries is evidence that prevention of these injuries should remain an important area of bicycle safety research and practice.     

Sexual behavior among Hispanic female adolescents in the United States

The purpose of this study was to identify factors associated with sexual activity in a national representative sample of Hispanic female adolescents. The subjects included all (n = 202) 15- to 19-year-old Hispanic female adolescents from the 1982 National Survey of Family Growth subdivided into Mexican-American (n = 119), Puerto Rican (n = 34), Central/South American (n = 23), Cuban (n = 9), and other Hispanic (n = 17) background groups. A total of 42% of the young women were sexually active. More Cubans (69.0%) and Central/South Americans (55.6%) reported sexual activity than the other groups, but the differences were not statistically significant. With multiple regression analysis, a significant amount of variation (total R2 = 0.367, P less than or equal to .001) in sexual activity was explained by the following variables: not being in school (22.5%), no religious affiliation (4.4%), age (3.3%), less church attendance (3.0%), older age at menarche (1.9%), and not living with both parents at age 14 years (1.9%). These findings suggest that maintaining social continuity in the areas of school, church affiliation and involvement, and family structure, as well as physical maturity are associated with Hispanic adolescent girls not becoming sexually active.     

Psychotropic Medication Use in United States Pediatric Emergency Department Visits

Objective and BackgroundLittle is known about pediatric psychotropic medication use in the emergency department (ED), despite a rise in mental and behavioral health visits. This study describes psychotropic medication use in a nationally representative sample of pediatric mental and behavioral health ED visits over a 14-year period.MethodsWe conducted a cross-sectional analysis of pediatric (6–17 years) mental and behavioral health ED visits using the National Hospital Ambulatory Medical Care Survey, 2006–2019. We describe administration of psychotropic medications by medication type, diagnosis, and over time. Using multivariable survey-weighted logistic regression, we examine associations between medication administration and sociodemographics.ResultsA psychotropic medication was administered in 11.4% of the estimated 11,792,860 pediatric mental and behavioral health ED visits in our sample. Benzodiazepines were administered most frequently (4.9% of visits). Visits with anxiety disorders had the highest frequency of psychotropic medication use (26.7%). Visits by Black non-Hispanic patients had a 60% decreased odds of medication administration compared to visits for White non-Hispanic patients. Visits with public compared to private insurance had a 3.5 times increased odds of psychotropic polypharmacy. The proportion of visits in which a psychotropic medication was administered did not change statistically over time.ConclusionsA psychotropic medication was administered in 1 in 10 pediatric mental and behavioral health ED visits. Use differed by sociodemographics but did not change over time. As more youth seek mental and behavioral health care in the ED, we must better understand appropriate medication use to ensure quality and equitable care.     

Subclinical thyroid disorders and cognitive performance among adolescents in the United States

Background  

Thyroid hormone plays a crucial role in the growth and function of the central nervous system. The purpose of the study was to examine the relationships between the status of subclinical thyroid conditions and cognition among adolescents in the United States.     

Access to medical care for children and adolescents in the United States

To evaluate access to health care for American children and adolescents, a telephone survey of a national random sample of households was conducted in which 2182 children 17 years or younger were studied. Approximately 10% had no medical insurance; 10% had no regular source of care; and 18% identified emergency rooms, community clinics, or hospital outpatient departments as their usual site of medical care. Children who were uninsured, poor, or nonwhite were less likely to have seen a physician in the past year (P less than .001), and uninsured children were less likely to have up-to-date immunizations. Logistic regression analyses revealed that poor, uninsured, or nonwhite children less frequently had a regular source of care; more frequently used emergency rooms, community clinics, and hospital outpatient departments as their regular providers; and more frequently encountered financial barriers to health care. Low-income or nonwhite children had much less access to care compared with children from more affluent or white families, independent of insurance status or health status.     

Human herpesvirus 8 seroprevalence among children and adolescents in the United States

We measured human herpesvirus-8 antibodies (K8.1 and orf73 enzyme immunoassays) in 4166 children, aged 6-17 years, in a U.S. cross-sectional survey. Forty-six were K8.1 seropositive (weighted seroprevalence: 1.1%) and 20 were orf73 seropositive (weighted seroprevalence 0.4%). K8.1 seropositivity was associated with asthma (odds ratio: 6.3; 95% confidence interval: 2.4-16.9) and hay fever (3.5; 1.1-11.0), and there were borderline associations with measures of crowding and low socioeconomic status.     

Visits to complementary and alternative medicine providers by children and adolescents in the United States.

OBJECTIVE: Determine the prevalence, patterns, costs, and predictors of visits to complementary and alternative medicine (CAM) providers and subsequent remedy use in a nationally representative pediatric sample. METHODS: The 1996 Medical Expenditure Panel Survey provided data on 7371 subjects < or =21 years of age. The primary outcome variable was CAM provider visits as defined by consulting a CAM provider "for health reasons." Predictors included sociodemographics, family resources, health status, parental CAM use, and perceptions and use of conventional medical care. Bivariate analyses and logistic regression determined independent factors associated with CAM use. RESULTS: Overall, 2.0% used CAM. Only 12.3% disclosed this use to their usual source of care (USC). The most common providers were chiropractors and clergy or spiritualists. The most common therapies were herbal remedies and spiritual healing. Mean amount spent per person on CAM visits was 73.40 US dollars and on remedies was 13.06 US dollars. Weighted estimates to the national pediatric population of annual expenditures on CAM visits and remedies were 127 million US dollars and 22 million US dollars, respectively. Significant factors independently associated with CAM visits were female gender, older age, good and very good perceived physical health as compared with excellent health, parental CAM use, and dissatisfaction with the quality of care received from the USC. CONCLUSIONS: Two percent of parents reported that their children consulted a CAM provider and rarely disclosed this use to their USC. While dissatisfaction with the quality of care by the USC and less good perceived physical health predicted CAM visits, parental CAM use was the most predictive.