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Frequent emergency room visits may reflect needed care for pediatric cancer patients


INDIANAPOLIS — Children with cancer who visit emergency departments frequently may be doing so because it’s an integral part of their care, not because they’ve received inadequate treatment before or are overusing such facilities, according to researchers at the Indiana University School of Medicine.

Rather, such visits likely reflect the risk of infections and other complications of treatment. Age and some socio-economic factors may also play a role, said Emily L. Mueller, M.D., M.Sc., assistant professor of pediatrics.

In a paper published in the early-view, online issue of the journal Pediatric Blood & Cancer, Dr. Mueller and colleagues analyzed admissions and treatment information from visits to emergency departments at children’s hospitals that contributed data to the Children’s Hospital Association’s Pediatric Health Information System database.

The researchers identified 17,943 children with cancer who made 26,770 emergency department visits over a period of one year. Children with four or more emergency room visits in a 12-month period, designated as “frequent ED utilizers,” accounted for 58 percent of the visits.

Those frequent utilizers tended to be younger, more often Hispanic, less likely to have private insurance and more likely to be living in urban areas.

However, more than half of the children brought to the emergency departments were admitted to the hospital. Of those sent home, nearly all first underwent laboratory testing, radiologic imaging or received medications such as antibiotics. In contrast, other studies have found that among children generally, nearly a third were sent home from emergency room visits without receiving any treatments beyond such over-the-counter drugs as acetaminophen or ibuprofen.

“The vast majority of children with cancer received some sort of intervention in the emergency department that they would not have been able to get by simply talking to a nurse or other health care professional on the telephone,” Dr. Mueller said.

Although the data available for the study is not conclusive, “we suspect that treatment in the emergency department is a fundamental part of the care needed by children with cancer,” Dr. Mueller said.

Dr. Mueller said her research was prompted in part by anecdotal complaints by parents of her pediatric patients with cancer about the quality of care their children received in emergency departments and a “lack of understanding of what their kids are going through.”

The study may be used to help identify children who are likely to become frequent emergency department utilizers, and therefore enable additional research “aimed at better understanding the patient experience and identifying measures to improve their care,” the authors said.

In addition to Dr. Mueller, the paper’s first author, researchers contributing to the study were Matt Hall, Ph.D., of the Children’s Hospital Association; Aaron E. Carroll, M.D., of the IU School of Medicine, Samir S. Shah, M.D., of the University of Cincinnati; and Michelle L. Macy, M.D., of the University of Michigan.