Determinants of persistent, multi-year, frequent emergency department use among children and young adults in three US states. Academic Article uri icon


  • OBJECTIVE: This study examines the factors associated with persistent, multi-year, and frequent emergency department (ED) use among children and young adults. METHODS: We conducted a retrospective secondary analysis using 2012 to 2017 Healthcare Cost and Utilization Project State Emergency Department Databases for children and young adults aged 0 to 19 who visited any ED in Florida, Massachusetts, and New York. We estimated the association between persistent frequent ED use and individuals' characteristics using multivariable logistic regression models. RESULTS: Among 1.3 million patients with 1.8 million ED visits in 2012, 2.9% (37,558) exhibited frequent ED use (4 visits in 2012) and accounted for 10.2% (181,138) of all ED visits. Longitudinal follow-up of frequent ED users indicated that 15.4% (5,770) remained frequent users periodically over the next one or two years, while 2.2% (831) exhibited persistent frequent use over the next three to five years. Over the 6-year study period, persistent frequent users had 31,551 ED visits at an average of 38.0 (standard deviation=16.2) visits. Persistent frequent ED use was associated with higher intensity of ED use in 2012, public health insurance coverage, inconsistent health insurance coverage over time, residence in non-metropolitan and lower-income areas, multimorbidity, and more ED visits for less medically urgent conditions. CONCLUSION: Clinicians and policymakers should consider the diverse characteristics and needs of pediatric persistent frequent ED users compared to broader definitions of frequent users when designing and implementing interventions to improve health outcomes and contain ED visit costs.

published proceedings

  • Acad Pediatr

author list (cited authors)

  • Giannouchos, T. V., Ukert, B., Pirrallo, R. G., Smith, J., Kum, H., Wright, B., & Dietrich, A.

complete list of authors

  • Giannouchos, Theodoros V||Ukert, Benjamin||Pirrallo, Ronald G||Smith, Jeremiah||Kum, Hye-Chung||Wright, Brad||Dietrich, Ann

publication date

  • September 2023