Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
J Am Coll Cardiol. 2018 Oct 9;72(15):1817-1825. doi: 10.1016/j.jacc.2018.07.055.
Data related to the epidemiology and resource utilization of congenital heart disease (CHD)-related emergency department (ED) visits in the pediatric population is limited.
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.
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.
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.
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.
有关儿科先天性心脏病（CHD）相关急诊科（ED）就诊的流行病学和资源利用数据有限。
本分析旨在描述全国儿科 CHD 相关 ED 就诊的估计情况，并评估医疗复杂性、住院、资源利用和死亡率。
这是对 2006 年至 2014 年全国急诊部抽样调查中 ED 就诊水平数据的一项流行病学分析。使用国际疾病分类第 9 版临床修订版（ICD-9-CM）代码识别年龄<18 岁的 CHD 患者。我们使用加权回归评估时间趋势，并检验了假设，即 CHD 患者的医疗复杂性、资源利用和死亡率更高。
共确定了 420452 例 CHD 相关 ED 就诊（95%置信区间[CI]：416897 至 422443 次就诊），占所有儿科 ED 就诊的 0.17%。患有 CHD 的患者<1 岁的可能性更高（43% vs. 13%），且≥1 种复杂慢性疾病的可能性更高（35% vs. 2%）。CHD 相关 ED 就诊的住院率更高（46% vs. 4%；调整后的优势比[OR]：1.89；95%CI：1.85 至 1.93），中位数 ED 费用更高（$1266[四分位距（IQR）：$701 至 $2093] vs. $741[IQR：$401 至 $1332]），死亡率更高（1% vs. 0.04%；调整后的 OR：1.25；95%CI：1.07 至 1.45）。CHD 相关 ED 就诊的调整后中位数费用从$1219（IQR：$673 至 $2138）增加到$1630（IQR：$901 至 $2799），而死亡率从 1.13%（95%CI：0.71%至 1.52%）降至 0.75%（95%CI：0.41%至 1.09%）%）在研究的 9 年中。
与无 CHD 的患者相比，因 CHD 到 ED 就诊的儿童代表了一个医疗复杂的人群，他们患有发病率、死亡率和资源利用增加的风险更高。9 年来，费用增加了，但死亡率有所改善。
