EMERGENCY DEPARTMENT UTILIZATION BY ADOLESCENTS

Purpose: To review adolescents' utilization of a hospital emergency department (ED) in a rural area, to identify their characteristics, and to explore their motivation to seek health care in this setting. Methods: A retrospective chart survey of all 4932 adolescent visits (ages 12-18 years, 55.5% females) to the ED in a small town with a population of 55,000 serving a rural area was conducted for the calendar year 1989. Chief complaints and diagnoses were retrospectively categorized according to six groups: injury, pulmonary problems, Ob/Gyn, infection, nonspecific pain (complaint)/ no diagnosis (diagnoses), and ''other.'' Results: There was an increasing number of visits with increasing age. Adolescents with private insurance, who accounted for 50% of patients, were more likely than self-paying adolescents (14%) and adolescents on Medicaid (36%) to have a primary care source and to have access to a telephone. Injury was the most common diagnosis with motor vehicle accidents (MVA) accounting for 15% of all injuries. Self-paying adolescents and those on Medicaid were more likely to be diagnosed with an infection or an Ob/Gyn problem than adolescents with health insurance. Only 5.9% of adolescents were admitted to the hospital service. 8.5% of adolescents were discharged from the ED without a diagnosis. 78% of these had complained about nonspecific pain. Conclusions: Many adolescents in this rural area were found not to have an identified primary care source and to seek health care in EDs. Illnesses that could have been prevented or treated in a more cost-effective setting thus become ''emergencies.'' Primary care sources are needed that are accessible and acceptable to adolescents.