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Acad Pediatr. 2019 Nov - Dec;19(8):942-947. doi: 10.1016/j.acap.2019.03.004. Epub 2019 Mar 7.

The Care of Adult Patients in Pediatric Emergency Departments.

Author information

Department of Emergency Medicine (M Samuels-Kalow), Massachusetts General Hospital, and. Electronic address:
Division of Emergency Medicine (MI Neuman), Boston Children's Hospital, Harvard Medical School, Boston, Mass.
Children's Hospital Association (J Rodean and M Hall), Lenexa, Kans.
Children's Hospital Association (J Rodean and M Hall), Lenexa, Kans; Division of Pediatric Emergency Medicine (JR Marin), Children's Hospital of Pittsburgh, Pittsburgh, Penn.
Section of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine (PL Aronson), Yale School of Medicine, New Haven, Conn.
Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics (SB Freedman), Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada.
Children's Health System of Texas (RB Morse), Dallas.
Division of Pediatric Medicine, Department of Pediatrics (E Cohen), The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Division of Emergency Medicine, Departments of Pediatrics and Emergency Medicine (HK Simon), Emory University School of Medicine, and Children's Healthcare of Atlanta, Atlanta Ga.
Divisions of Hospital Medicine and Infectious Diseases, Department of Pediatrics (SS Shah), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Division of Emergency Medicine, Department of Pediatrics (ER Alpern), Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill.



Adult patients are increasingly receiving care in pediatric emergency departments (PEDs), but little is known about the epidemiology of these visits. The goals of this study were to examine the characteristics of adult patients (≥21 years) treated in PEDs and to describe the variation in resource utilization across centers.


We conducted a cross-sectional study examining visits to 30 PEDs (2012-2016) using the Pediatric Health Information System. Visits were categorized using All Patient Refined Diagnosis Related Groups and compared between age cohorts. We used multivariable logistic models to examine variation in demographics, utilization, testing, treatment, and disposition.


There were 12,958,626 visits to the 30 PEDs over 5 years; 70,636 (0.6%) were by adults. Compared with children, adult patients had more laboratory testing (49% vs 34%), diagnostic imaging (32% vs 29%), and procedures (48% vs 31%), and they were more often admitted (17% vs 11%) or transferred (21% vs 0.7%) (P < .001 for all). In multivariable analysis, older age, black race, Hispanic ethnicity, and private insurance were associated with decreased odds of admission in adults seen in PEDs. Across PEDs, the admission rates (7%-25%) and transfer rates (6%-46%) for adults varied.


Adult patients cared for at PEDs have higher rates of testing, diagnostic imaging, procedures, and admission or transfer. There is wide variation in the care of adults in PEDs, highlighting the importance of further work to identify the optimal approach to adults who present for care in pediatric centers.


adult patients; pediatric emergency medicine; transitions in care

[Available on 2020-11-01]

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