Trends in Emergency Department Visits for Children, 2016-2023

AI Summary

ED visits and costs rose for psychiatric and behavioural disorders and substance abuse, with annual visit increase +2.8% and cost increase +10.6%.
COVID-19 triggered sharp ED encounter declines, then post-pandemic rises, notably eye (+27.8% annually) and ENT/dental/mouth (+20.0% annually) presentations.
Several diagnoses declined between 2016 to 2023, including skin and soft tissue (-9.0%), urinary tract (-4.9%), and trauma (-4.6%) encounters.

AI Summary

Overall trends shifted by diagnosis, with increases in psychiatric/behavioral diseases and substance abuse (+2.8% annually; 95% CI, 1.2, 4.4) and endocrine/metabolic/nutritional diseases (+3.7%; 95% CI, 0.4, 7.2).

In time series analyses, the COVID-19 pandemic was associated with sharp declines in encounters, followed by post-pandemic increases, especially for eye disease (+27.8% annually; 95% CI, 21.5, 34.5), ear, nose and throat (ENT), dental/mouth disease (+20.0%; 95% CI, 15.4, 24.7), fluid/electrolyte disorders (+19.7%; 95% CI, 13.9, 25.7), and respiratory disease (+18.7%; 95% CI, 6.2, 32.6).

Post-pandemic cost increase was greatest for ENT/dental/mouth disease (+24.6%; 95% CI, 16.9, 32.7), eye disease (+24.1%; 95% CI, 15.3, 33.6), and psychiatric/behavioral diseases and substance abuse (+12.1%; 95% CI, 5.1, 19.6).

Basic summary

J Pediatr. 2026 Aug 19:115286. doi: 10.1016/j.jpeds.2026.115286. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate longitudinal changes in diagnoses related to emergency department (ED) utilization and associated costs among children in US EDs.

STUDY DESIGN: We performed a serial cross-sectional study using the 2016-2023 Nationwide Emergency Department Sample, a nationally representative all-payor ED sample. We evaluated longitudinal changes in diagnoses (using the Diagnosis Grouping System) and costs (inflation adjusted 2023 dollars) over time overall utilizing negative binomial regression and log-linear regression, respectively. We then performed interrupted time-series analyses to account for the onset of the COVID-19 pandemic in 2020.

RESULTS: We identified 198,256,299 ED encounters. Overall trends shifted by diagnosis, with increases in psychiatric/behavioral diseases and substance abuse (+2.8% annually; 95% CI, 1.2, 4.4) and endocrine/metabolic/nutritional diseases (+3.7%; 95% CI, 0.4, 7.2). Several diagnoses declined, including skin/soft tissue disease (-9.0%; 95% CI, -13.0, -4.8), urinary tract disease (-4.9%; 95% CI, -7.1, -2.7), and trauma (-4.6%; 95% CI, -7.1, -2.1). In time series analyses, the COVID-19 pandemic was associated with sharp declines in encounters, followed by post-pandemic increases, especially for eye disease (+27.8% annually; 95% CI, 21.5, 34.5), ear, nose and throat (ENT), dental/mouth disease (+20.0%; 95% CI, 15.4, 24.7), fluid/electrolyte disorders (+19.7%; 95% CI, 13.9, 25.7), and respiratory disease (+18.7%; 95% CI, 6.2, 32.6). Inflation-adjusted costs increased in psychiatric/behavioral diseases and substance abuse (+10.6%; 95% CI, 8.2, 12.9), systemic states (+9.5%; 95% CI, 3.9, 15.3), and endocrine/metabolic/nutritional diseases (+6.3%; 95% CI, 0.7, 12.3). Post-pandemic cost increase was greatest for ENT/dental/mouth disease (+24.6%; 95% CI, 16.9, 32.7), eye disease (+24.1%; 95% CI, 15.3, 33.6), and psychiatric/behavioral diseases and substance abuse (+12.1%; 95% CI, 5.1, 19.6).

CONCLUSIONS: We identified changes in ED presentations and costs over time, with notable changes for psychiatric/behavioral and substance abuse conditions. These findings have implications for health systems and policymakers amid major shifts in ED use over the past decade.

PMID:42617794 | DOI:10.1016/j.jpeds.2026.115286

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