Pediatric emergency department use by adults with chronic pediatric disorders

Objective: To describe pediatric emergency department use by adults with chronic pediatric disorders, known as transition patients. Design: Retrospective descriptive study. Setting: The pediatric emergency department of a tertiary care pediatric hospital during calendar year 2005. Participants: All patients presenting to the pediatric emergency department during the study period. Main Outcome Measures: Association of presenting complaint with the patient's chronic pediatric disorder, emergency department interventions and dispositions, and duration of inpatient admissions. Results: Patient encounters totaled 43 621, with 445 (1%) involving adult patients. Transition patients accounted for 197 (44%) of the adult encounters. Eighty-nine transition patient encounters (45%) were for complaints unrelated to the patients' chronic pediatric disorders. Only 14 (7%) transition patient visits did not involve diagnostic studies or procedures. Transition patients were 2.1 times (95% confidence interval, 1.8-2.5; P<.001) more likely to require admission than pediatric patients and were 4.5 times (95% confidence interval, 3.3-6.1; P<.001) more likely to require intensive care. Median length of stay for admitted transition patients was 4 days (range, 1-35 days) compared with 2 days (range, 1-80 days) for pediatric patients (P<.001). Conclusions: A substantial number of adult patients with chronic pediatric disorders use the pediatric emergency department and often present with complaints unrelated to their pediatric conditions. They have high rates of hospital and intensive care unit admissions. Pediatric hospitals should be prepared with adequate resources and training to deal with these complex adult patients.