Predicting Low-Resource-Intensity Emergency Department Visits in Children

Margaret Samuels-Kalow, Alon Peltz, Jonathan Rodean, Matthew Hall, Elizabeth R. Alpern, Paul L. Aronson, Jay G. Berry, Kathy N. Shaw, Rustin B. Morse, Stephen B. Freedman, Eyal Cohen, Harold K. Simon, Samir S. Shah, Yiannis Katsogridakis, Mark I. Neuman

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Objectives: Interventions to reduce frequent emergency department (ED) use in children are often limited by the inability to predict future risk. We sought to develop a population-based model for predicting Medicaid-insured children at risk for high frequency (HF) of low-resource-intensity (LRI) ED visits. Methods: We conducted a retrospective cohort analysis of Medicaid-insured children (aged 1–18 years) included in the MarketScan Medicaid database with ≥1 ED visit in 2013. LRI visits were defined as ED encounters with no laboratory testing, imaging, procedures, or hospitalization; and HF as ≥3 LRI ED visits within 365 days of the initial encounter. A generalized linear regression model was derived and validated using a split-sample approach. Validity testing was conducted examining model performance using 3 alternative definitions of LRI. Results: Among 743,016 children with ≥1 ED visit in 2013, 5% experienced high-frequency LRI ED use, accounting for 21% of all LRI visits. Prior LRI ED use (2 visits: adjusted odds ratio = 3.5; 95% confidence interval, 3.3, 3.7; and ≥3 visits: adjusted odds ratio = 7.7; 95% confidence interval, 7.3, 8.1) and presence of ≥3 chronic conditions (adjusted odds ratio = 1.7; 95% confidence interval, 1.6, 1.8) were strongly associated with future HF-LRI ED use. A model incorporating patient characteristics and prior ED use predicted future HF-LRI ED utilization with an area under the curve of 0.74. Conclusions: Demographic characteristics and patterns of prior ED use can predict future risk of HF-LRI ED use in the following year. Interventions for reducing low-value ED use in these high-risk children should be considered.

Original languageEnglish (US)
Pages (from-to)297-304
Number of pages8
JournalAcademic Pediatrics
Issue number3
StatePublished - Apr 2018


  • emergency medicine
  • pediatrics
  • predictive model
  • utilization

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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