Steven M Green1. 1. Department of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, Loma Linda, CA, USA. steve@viridissimo.com
Abstract
STUDY OBJECTIVE: A previous single-region study has suggested that acuity varies by patient age in ways that may affect subspecialty critical care skills retention. This study seeks to independently confirm or refute these findings by using the National Hospital Ambulatory Medical Care Survey (NHAMCS), a large nationally representative database of emergency department (ED) visits. METHODS: Using 8 years of NHAMCS data composed of 288,199 ED visits, the following 6 measures of patient acuity were weighted and graphically stratified by patient age: triage category, hospital admission, critical care unit admission, death in the ED, cardiopulmonary resuscitation, and tracheal intubation. Their relative frequency was then compared between adults and children (<18 years). RESULTS: All measures of acuity increased with age and were higher in adults versus children: highest triage category odds ratio 1.3, hospital admission odds ratio 4.2, critical care unit admission odds ratio 4.5, death in the ED odds ratio 5.8, cardiopulmonary resuscitation odds ratio 4.7, and tracheal intubation odds ratio 2.5. CONCLUSION: This analysis of a large, nationally representative ED sample found substantial age-based differences in patient acuity that can inform discussion about subspecialty critical care skills retention.
STUDY OBJECTIVE: A previous single-region study has suggested that acuity varies by patient age in ways that may affect subspecialty critical care skills retention. This study seeks to independently confirm or refute these findings by using the National Hospital Ambulatory Medical Care Survey (NHAMCS), a large nationally representative database of emergency department (ED) visits. METHODS: Using 8 years of NHAMCS data composed of 288,199 ED visits, the following 6 measures of patient acuity were weighted and graphically stratified by patient age: triage category, hospital admission, critical care unit admission, death in the ED, cardiopulmonary resuscitation, and tracheal intubation. Their relative frequency was then compared between adults and children (<18 years). RESULTS: All measures of acuity increased with age and were higher in adults versus children: highest triage category odds ratio 1.3, hospital admission odds ratio 4.2, critical care unit admission odds ratio 4.5, death in the ED odds ratio 5.8, cardiopulmonary resuscitation odds ratio 4.7, and tracheal intubation odds ratio 2.5. CONCLUSION: This analysis of a large, nationally representative ED sample found substantial age-based differences in patient acuity that can inform discussion about subspecialty critical care skills retention.