Emergency room use reaches a record high

Visits to hospital emergency departments increased to an all-time high of 136 million in 2009, according to estimates released by the Centers for Disease Control and Prevention. This represents almost a 10% increase from the 2008 figure of 123.8 million.

The CDC study is one of three examinations of ER use being released today at the American College of Emergency Physicians meeting in San Francisco.

According to the CDC, patients under 15 accounted for 21% of emergency visits in 2009; patients between 15 and 24 accounted for 15%; patients between 25 and 44 accounted for 28%; patients between 45 and 64, 21%; and patients 65 and older, 15%.

Breaking visits down by gender and race, the CDC reported that females visited the ER at a rate of 48 visits per 100 people, while males had a rate of 42. Whites had a rate of 41 visits per 100 persons, while blacks had a rate of 84.

The expected sources of payments for ER visits were private insurance, 39%; Medicaid or State Children's Health Insurance Program, 29%; Medicare, 17%; other and unknown 5% each. Nineteen percent said they had no insurance. (Numbers are higher than 100% because some patients had multiple sources of payment.)

The most common reasons for visiting an ER included stomach and abdominal pain, 9.6 million; fever, 7.4 million; chest pain, 7.2 million; cough, 4.7 million; headache, 4 million; and shortness of breath and back symptoms, 3.7 million each.

Also, in two new studies published in the Annals of Emergency Medicine, the authors suggest that increasing concerns about medical malpractice litigation led to higher hospital admittance rates.

In one, physicians surveyed during an 18-month study period said medical-legal concerns were the main reason for admitting 11% of ER patients with acute coronary syndrome. In 27% of the cases, the doctors said they would not have chosen hospitalization if they were the patients.

In the other study, researchers studied ER visits in 27 urban, suburban and rural ERs in New Jersey and New York and compared admission rates for congestive heart failure patients in 1996 and 2010. They found the percentage of patients discharged from the ER decreased to 9.1% from 24.4%. The authors said they suspected concern about litigation as the main reason for the decrease.