A Comparison of Patient and Dental Condition Characteristics Presenting to a Pediatric Hospital Emergency Department Versus Urgent Care with Non-Emergency Dental Complaints

Abstract

Background: Utilization of hospital emergency departments (EDs) for dental complaints is increasing. Approximately 79% of dental-related ED visits are for non-emergency conditions. Most visits are avoidable, and directing them to alternative settings could result in substantial savings to the United States health care system. Methods: This retrospective cohort study assessed patient and dental condition characteristics associated with presentation to a pediatric hospital ED versus urgent care (UC) for after-hours non-emergency complaints from 2014 to 2016. Data were collected from the electronic medical records at Seattle Children’s Hospital from patients presenting from 5:00 pm to 10:30 pm Monday through Friday and 11:00 am to 8:00 pm on weekends and holidays. Logistic regression was performed to estimate adjusted odds ratios with 95% confidence intervals (CI) to assess the association of characteristics such as age, sex, dental home, and triage acuity with presentation to the ED versus UC. Differences in types of medical and dental services in the ED versus UC were compared using Chi-squared testing. Results: A total of 266 visits were assessed, 189 (71.0%) visits occurred in the ED, and 77 (29.0%) occurred in the UC. Children with a community clinic dental home had a 4.05-fold increased odds of presenting to the ED compared to those with private practice dental homes (95% CI 1.06 - 15.52). For every unit decrease in triage acuity there was a 91% lower odds of presenting to the ED (95% CI 0.04 – 0.19). More children in the ED received at least one medication (60% versus 26%, p<0.001), non-narcotic analgesics (36% and 20%, p=0.01), at least one prescription for medication (31% versus 15%, p=0.004), prescription for non-narcotic analgesics (10% and 2%, p=0.03), primary tooth extraction (37% versus 24%, p=0.04), and interim tooth restoration (12% versus 2%, p=0.01). Fewer children seen in the ED received definitive tooth restoration (0% versus 9%, p<0.001). Conclusions: Future strategies to reduce non-emergency dental-related ED visits should focus on patient and provider education, especially at community clinic dental offices, to triage and direct patients to low acuity venues such as UCs with dental services.