86.04 Non-traumatic Surgical Emergencies in Children: An Examination of ED Visits across the US

A. A. Shah1, K. Williams1, E. Cornwell1, T. Oyetunji3, B. Nwomeh2  1Howard University College Of Medicine,Surgery,Washington, DC, USA 2Nationwide Children’s Hospital,Pediatric Surgery,Columbus, OH, USA 3Children’s Mercy Hospital- University Of Missouri Kansas City,Pediatric Surgery,Kansas City, MO, USA

Introduction:  Pediatric patients comprise a quarter of emergency department (ED) visits in the US. Utilization of ED services by children for surgical emergencies has not been well studied. The aim of this study is to identify the most common pediatric surgical emergencies presenting to the ED.

Methods:  The Nationwide Emergency Department Sample (2009-2012) was queried for pediatric patients (≤18 y) with a primary diagnosis of strangulated/incarcerated hernias, intestinal obstruction, volvuli, intussusception, peri-anal/rectal abscesses, appendicitis and cholecystitis. Patients with traumatic injuries were excluded. Univariate analysis was then performed to describe patient demographics, payor status, discharge disposition, hospital characteristics and outcomes. Any major diagnostic or major therapeutic procedures performed were regarded as major operative intervention. Primary outcome measures were inpatient admission and operative intervention after admission.

Results: A total of 113,699 records were analyzed weighted to present 509,606 ED visits nationally. Average age was 11.4 (±4.9) years with a male preponderance (60.2%). Appendicitis was the most common reason for the presentation to the ED (82.5%), followed by intestinal obstruction (6.3%) and abscesses (3.9%). A total of 58.3% required inpatient admission, whereas 14.2 % were transferred to other facilities. Of those requiring admission, 89.3% underwent major surgical intervention. Highest rates of operative interventions were observed for appendicitis (96.3%), followed by hernias (93.4%) and volvuli (89.0%). Median length of hospital stay was 2 days (IQR:1-3). Routine discharge home was common (97.2%), followed by home with home health (1.8%) and transfer to a short term care facility (1.0%).

Conclusion: Among the common pediatric surgical emergencies examined, more than half require inpatient admission with greater than three-quarters undergoing operative intervention. Discharge to home was routine after hospital admission. Appropriate identification of children at risk for admission can help expedite ED triage and ensure timely surgical care delivery.