National Hospital Ambulatory Medical Care Survey: 2011 ... - CDC

National Hospital Ambulatory Medical Care Survey: 2011 Emergency Department Summary Tables □ Page 1

National Hospital Ambulatory Medical Care Survey: 2011 Emergency Department Summary Tables The Ambulatory and Hospital Care Statistics Branch is pleased to release the most current nationally representative data on ambulatory care visits to hospital emergency departments (ED) in the United States. Statistics are presented on selected hospital, patient, and visit characteristics based on data collected in the 2011 National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS is an annual nationally representative sample survey of visits to EDs, outpatient departments, and ambulatory surgical centers (ASCs) of nonfederal short-stay and general hospitals (starting in 2009), as well as freestanding ASCs (starting in 2010). The sampling frame for the 2011 NHAMCS was constructed from SDI’s “Healthcare Market Index, Updated July 15, 2006” and “Hospital Market Profiling Solution, Second Quarter, 2006.” NHAMCS uses a multi-stage probability design with samples of primary sampling units (PSUs), hospitals within PSUs, and patient visits within emergency service areas (ESAs). A total of 483 hospitals were selected for the 2011 NHAMCS, of which 370 were in scope and had eligible EDs. Of these, 322 participated, yielding an unweighted ED response rate of 87.0 percent. All 419 emergency services areas (ESAs) were selected from the EDs. Of these, 387 responded fully or adequately by providing forms for at least half of their expected visits based on the total number of visits during the reporting period, and 5 responded minimally (i.e., they provided fewer than half of their expected forms). In all, 31,084 Patient Record forms (PRFs) were submitted. The resulting unweighted ESA sample response rate was 92.4 percent, and the overall unweighted two stage sampling response rate was 80.4 percent (81.3% weighted). Response rates have been adjusted to exclude minimal participants. The 2011 NHAMCS was conducted from December 27, 2010 through December 25, 2011. The U.S. Bureau of the Census was the data collection agent for the 2011 NHAMCS. Hospital staff or Census field representatives completed a PRF for a sample of about 100 ED visits during a randomly assigned 4–week reporting period. The PRF may be viewed at: http://www.cdc.gov/nchs/data/ahcd/nhamcs100ed_2011.pdf. Data processing and medical coding were performed by SRA International, Inc., Durham, North Carolina. As part of the quality assurance procedure, a 10 percent quality control sample of ED survey records was independently keyed and coded, with an error rate of 0.5 percent. For items that required medical coding, discrepancy rates ranged between 0.5–0.8 percent. For further details, see 2011 NHAMCS Public Use Data File Documentation at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHAMCS/doc11.pdf. Web table estimates are based on sample data weighted to produce annual national estimates and include standard errors. Because of the complex multistage design of NHAMCS, a sample weight is computed for each sample visit that takes all stages of design into account. The survey data are inflated or weighted to produce unbiased national annual estimates. The visit weight includes four basic components: inflation by reciprocals of selection probabilities, adjustment for nonresponse, population ratio adjustments, and weight smoothing. Estimates of the sampling variability were calculated using Taylor approximations in SUDAAN, which take into account the complex sample design of NHAMCS. Detailed information on the design, conduct, and estimation procedures of 2011 NHAMCS are discussed in the 2011 NHAMCS Public Use Data File Documentation.

National Hospital Ambulatory Medical Care Survey: 2011 Emergency Department Summary Tables □ Page 2

As in any survey, results are subject to sampling and nonsampling errors. Nonsampling errors include reporting and processing errors as well as biases due to nonresponse and incomplete response. In 2011, race data were missing for 14.8 percent of visits, and ethnicity data were missing for 18.5 percent of visits. The National Center for Health Statistics uses model-based single imputation for NHAMCS race and ethnicity data. The race imputation is restricted to three categories (white, black, and other) based on research by an internal work group and on quality concerns with imputed estimates for race categories other than white and black. The imputation technique is described in more detail in the 2011 NHAMCS Public Use Data File Documentation. Information on missing data for other variables is indicated in table footnotes. In the following tables, estimates are not presented if they are based on fewer than 30 cases in the sample data; only an asterisk (*) appears in the tables. The relative standard error (RSE) of an estimate is obtained by dividing the standard error by the estimate itself. The result is then expressed as a percentage of the estimate. Estimates based on 30 or more cases include an asterisk if the RSE of the estimate exceeds 30 percent.

Table 1. Emergency department visits by selected hospital characteristics: United States, 2011

Selected hospital characteristics All visits

Number of visits in thousands (standard error in thousands) 136,296 (6,413)

Percent distribution (standard error of percent) 100.0 ...

Number of visits per 100 persons per year1 (standard error of rate) 44.5 (2.1)

Ownership Voluntary Government Proprietary

98,021 24,504 13,772

(6,478) (3,367) (3,348)

71.9 18.0 10.1

(3.1) (2.5) (2.3)

32.0 8.0 4.5

(2.1) (1.1) (1.1)

114,150 22,147

(6,184) (3,060)

83.8 16.2

(2.1) (2.1)

44.3 45.2

(2.4) (6.3)

24,263 29,929 55,410 26,696

(2,380) (2,794) (4,582) (2,304)

17.8 22.0 40.7 19.6

(1.6) (1.8) (2.4) (1.6)

44.3 45.2 48.7 37.2

(4.3) (4.2) (4.0) (3.2)

23,764 112,532

(2,906) (6,693)

17.4 82.6

(2.2) (2.2)

7.8 36.7

(0.9) (2.2)

62,506 73,791

(5,684) (5,233)

45.9 54.1

(3.3) (3.3)

20.4 24.1

(1.9) (1.7)

31,918 35,781 36,437 32,161

(4,354) (4,729) (4,081) (4,120)

23.4 26.3 26.7 23.6

(3.0) (3.2) (2.9) (2.7)

10.4 11.7 11.9 10.5

(1.4) (1.5) (1.3) (1.3)

Metropolitan status2,3,4 MSA Non-MSA Geographic region4 Northeast Midwest South West Teaching hospital Yes Non-teaching hospital5 Trauma center Yes No or blank Season6 Winter Spring Summer Fall … Category not applicable. 1

Visit rates for region are based on the July 1, 2011, set of the estimates of the civilian noninstitutional population of the United States as developed by the Population Division, U.S. Census Bureau. 2

MSA is metropolitan statistical area.

3

Population estimates by MSA are based on estimates of the civilian noninstitutionalized population of the United States as of July 1, 2011, from the 2011 National Health Interview Survey, National Center for Health Statistics, compiled according to the December 2009 Office of Management and Budget definitions of core-based statistical areas. See http://www.census.gov/population/metro/ for more about metropolitan statistical area definitions. 4

For geographic region and MSA, population denominators are different for each category and thus do not add to total population rate. For other variables, the denominator is the total population. 5

Includes a small percentage of hospitals with unknown or blank teaching status (0.7 percent).

6

Winter is December 22 through March 19; spring is March 20 through June 20; summer is June 21 through September 22; and fall is September 23 through December 21. NOTE: Numbers may not add to totals because of rounding. SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

Table 2. Emergency department visits by patient age, sex, and residence: United States, 2011 Number of visits in Percent distribution thousands (standard (standard error Selected patient characteristics error in thousands) of percent) All visits 136,296 (6,413) 100.0 ...

Number of visits per 100 persons per year1 (standard error of rate) 44.5 (2.1)

Age1 Under 15 years Under 1 year 1–4 years 5–14 years 15–24 years 25–44 years 45–64 years 65 years and over 65–74 years 75 years and over

24,823 3,485 9,773 11,565 22,150 39,124 29,828 20,372 8,208 12,163

(1,724) (303) (737) (823) (1,140) (1,997) (1,537) (1,172) (518) (729)

18.2 2.6 7.2 8.5 16.3 28.7 21.9 14.9 6.0 8.9

(0.9) (0.2) (0.4) (0.4) (0.3) (0.6) (0.5) (0.5) (0.2) (0.3)

40.6 87.3 60.5 28.2 51.7 48.7 36.4 50.8 36.9 68.2

(2.8) (7.6) (4.6) (2.0) (2.7) (2.5) (1.9) (2.9) (2.3) (4.1)

74,621 11,385 13,289 22,534 15,381 4,353 7,678 61,676 13,439 8,861 16,590 14,446 3,855 4,485

(3,622) (820) (746) (1,192) (862) (296) (498) (2,890) (945) (463) (906) (768) (283) (293)

54.7 8.4 9.8 16.5 11.3 3.2 5.6 45.3 9.9 6.5 12.2 10.6 2.8 3.3

(0.4) (0.5) (0.2) (0.4) (0.3) (0.2) (0.2) (0.4) (0.5) (0.2) (0.3) (0.3) (0.1) (0.2)

47.6 38.1 62.6 55.1 36.4 36.6 72.1 41.2 43.0 41.0 42.1 36.4 37.2 62.4

(2.3) (2.7) (3.5) (2.9) (2.0) (2.5) (4.7) (1.9) (3.0) (2.1) (2.3) (1.9) (2.7) (4.1)

126,297 2,557 1,092 1,401 4,949

(5,984) (184) (160) (135) (475)

92.7 1.9 0.8 1.0 3.6

(0.4) (0.1) (0.1) (0.1) (0.3)

41.2 74.2 171.7 0.5 1.6

(2.0) (5.3) (25.1) (0.0) (0.2)

Sex and age1 Female Under 15 years 15–24 years 25–44 years 45–64 years 65–74 years 75 years and over Male Under 15 years 15–24 years 25–44 years 45–64 years 65–74 years 75 years and over Patient residence Private residence1 Nursing home2 Homeless3 Other Unknown or blank ...Category not applicable. 0.0 Quantity more than zero but less than 0.05. 1

Visit rates for age, sex, and private residence are based on the July 1, 2011, set of estimates of the civilian noninstitutional population of the United States as developed by the Population Division, U.S. Census Bureau. 2

Visit rates for nursing home residents are based on the 2011 population denominators from the Center for Clinical Standards and Certification Group, Centers for Medicare and Medicaid Services. 3

Visit rates for the homeless people are based on The 2011 Annual Homeless Assessment Report to Congress by the U.S. Department of Housing and Urban Development. NOTE: Numbers may not add to totals because of rounding. SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

Table 3. Emergency department visits by patient race and age, and ethnicity: United States, 2011 Number of visits in thousands (standard Percent distribution Patient characteristics error in thousands) (standard error of percent) All visits 136,296 (6,413) 100.0 ...

Number of visits per 100 persons per year (standard error of rate)1 44.5 (2.1)

Race and age2,3 White Under 15 years 15–24 years 25–44 years 45–64 years 65–74 years 75 years and over Black or African American Under 15 years 15–24 years 25–44 years 45–64 years 65–74 years 75 years and over Other3 Ethnicity and race2,3 Hispanic or Latino Not Hispanic or Latino White Black or African American Other

98,147 16,766 15,254 27,800 21,760 6,410 10,156 32,627 6,708 6,032 9,710 7,025 1,511 1,640 5,523

(4,872) (1,164) (885) (1,499) (1,188) (387) (610) (2,676) (747) (493) (833) (636) (228) (291) (819)

72.0 12.3 11.2 20.4 16.0 4.7 7.5 23.9 4.9 4.4 7.1 5.2 1.1 1.2 4.1

(1.5) (0.7) (0.4) (0.6) (0.5) (0.2) (0.3) (1.4) (0.5) (0.3) (0.5) (0.4) (0.1) (0.2) (0.6)

40.9 37.3 47.6 45.0 32.6 33.9 65.0 82.9 72.9 91.9 92.6 73.1 72.5 117.5 20.3

(2.0) (2.6) (2.8) (2.4) (1.8) (2.0) (3.9) (6.8) (8.1) (7.5) (7.9) (6.6) (10.9) (20.8) (3.0)

19,206 117,091 81,185 31,514 4,392

(1,649) (5,640) (4,216) (2,627) (706)

14.1 85.9 59.6 23.1 3.2

(1.0) (1.0) (1.6) (1.4) (0.5)

37.4 45.9 41.7 85.2 18.7

(3.2) (2.2) (2.2) (7.1) (3.0)

...Category not applicable. 1

Visit rates are based on the July 1, 2011, set of estimates of the civilian noninstitutional population of the United States as developed by the Population Division, U.S. Census Bureau.

2

The race groups, white, black or African American, and other include persons of Hispanic and not Hispanic origin. Persons of Hispanic origin may be of any race. For 2011, race data were missing for 14.8 percent of visits, and ethnicity data were missing for 18.5 percent of visits. The National Center for Health Statistics uses model-based single imputation for NHAMCS race and ethnicity data. The race imputation is restricted to three categories (white, black, and other) based on research by an internal work group and on quality concerns with imputed estimates for race categories other than white and black. The imputation technique is described in more detail in the 2011 NHAMCS Public Use Data File documentation, available at: ftp:// ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHAMCS/doc11.pdf.

3

Other race includes the categories of Asian, Native Hawaiian or other Pacific Islander, American Indian or Alaska Native, and persons with more than one race. NOTE: Numbers may not add to totals because of rounding. SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

Table 4. Wait time at emergency department visits: United States, 2011 Visit characteristic All visits



Time spent waiting to see a MD, DO, PA or NP 1 Fewer than 15 minutes 15–59 minutes 1 hour, but less than 2 hours 2 hours, but less than 3 hours 3 hours, but less than 4 hours 4 hours, but less than 6 hours 6 hours or more Not applicable Blank

36,845 55,477 18,429 6,541 2,142 1,407 937 4,292 10,227

(2,434) (2,887) (1,176) (626) (298) (269) (149) (396) (1,565)

27.0 40.7 13.5 4.8 1.6 1.0 0.7 3.1 7.5

(1.4) (1.0) (0.6) (0.4) (0.2) (0.2) (0.1) (0.2) (1.1)

Time spent in the emergency department Less than 1 hour 1 hour, but less than 2 hours 2 hours, but less than 4 hours 4 hours, but less than 6 hours 6 hours, but less than 10 hours 10 hours, but less than 14 hours 14 hours, but less than 24 hours 24 hours or more Blank

16,198 33,184 47,537 20,420 10,487 2,134 1,340 794 4,202

(1,020) (1,776) (2,476) (1,256) (762) (229) (128) (96) (1,006)

11.9 24.3 34.9 15.0 7.7 1.6 1.0 0.6 3.1

(0.6) (0.7) (0.5) (0.5) (0.5) (0.2) (0.1) (0.1) (0.7)

Patient arrived in emergency department after business hours 2 Yes No Blank

81,428 53,700 *1,169

(3,799) (2,581) (904)

59.7 39.4 * 0.9

(0.5) (0.5) (0.7)

...Category not applicable *Figure does not meet standards of reliability or precision. 1

MD is medical doctor, DO is doctor of osteopathy, PA is physician assistant, NP is nurse practitioner. The median waiting time to see a MD, DO, PA, or NP was 27.0 minutes; the mean waiting time to see a MD, DO, PA, or NP was 48.9 minutes. 2

Business hours defined as Monday through Friday. 8 a.m. to 5 p.m. NOTE: Numbers may not add to totals because of rounding. SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

Table 5. Mode of arrival at emergency department, by patient age: United States, 2011 Patient's mode of arrival Number of visits Total Patient age in thousands Ambulance Other Percent distribution (standard error of percent) All visits 136,296 100.0 15.7 (0.5) 79.9 (0.6)

Unknown or blank 4.5

(0.4)

4.6 4.3 4.6 4.7 4.4 4.3 4.6 4.7 4.9 4.5

(0.5) (1.0) (0.7) (0.7) (0.6) (0.5) (0.5) (0.6) (0.7) (0.7)

Age Under 15 years Under 1 year 1–4 years 5–14 years 15–24 years 25–44 years 45–64 years 65 years and over 65–74 years 75 years and over

24,823 3,485 9,773 11,565 22,150 39,124 29,828 20,372 8,208 12,163

NOTE: Numbers may not add to totals because of rounding. SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

5.4 5.7 4.5 6.1 10.7 11.7 19.7 35.2 24.8 42.2

(0.5) (1.1) (0.7) (0.6) (0.7) (0.5) (0.9) (1.1) (1.4) (1.4)

90.0 90.0 90.9 89.2 84.9 84.0 75.8 60.1 70.3 53.3

(0.8) (1.4) (1.1) (1.0) (0.8) (0.7) (1.0) (1.1) (1.5) (1.4)

Table 6. Expected source(s) of payment at emergency department visits: United States, 2011 Expected source of payment All visits Private insurance Medicaid or CHIP2 Medicare Medicare and Medicaid3 No insurance4 Self-pay No charge or charity Workers' compensation Other Unknown or blank

Number of visits in thousands1 (standard error in thousand) 136,296 (6,413) 47,600 (2,687) 43,327 (2,562) 25,060 (1,472) 5,771 (479) 21,744 (1,488) 19,524 (1,287) 2,767 (807) 1,503 (140) 5,592 (877) 7,867 (1,126)

Percent of visits (standard error of percent) … ... 34.9 (1.0) 31.8 (1.1) 18.4 (0.6) 4.2 (0.3) 16.0 (0.7) 14.3 (0.7) 2.0 (0.6) 1.1 (0.1) 4.1 (0.6) 5.8 (0.8)


Combined total of expected sources of payment exceeds ''all visits'' and ''percent of visits'' exceed 100% because more than one source of payment may be reported per visit.

2

CHIP is Children's Health Insurance Program.

3

The visits in this category are also included in both the Medicare and the Medicaid or CHIP categories.

4

''No insurance'' is defined as having only self-pay, no charge, or charity as payment sources. The individual self-pay and no charge or charity categories are not mutually exclusive. SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

Table 7. Triage status of emergency department visits, by selected patient characteristics: United States, 2011 Number of visits in Level 3 Level 4 Patient and visit characteristics thousands Total Level 1 (immediate) Level 2 (emergent) (urgent) (semiurgent) Level 5 (nonurgent) Percent distribution (standard error of percent) All visits 136,296 100.0 1.2 (0.2) 10.7 (0.6) 42.3 (1.1) 35.5 (1.0) 8.0 (0.7)

*2.2

(0.8)

Age Under 15 years Under 1 year 1–4 years 5–14 years 15–24 years 25–44 years 45–64 years 65 years and over 65–74 years 75 years and over

No triage1

24,823 3,485 9,773 11,565 22,150 39,124 29,828 20,372 8,208 12,163

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

0.7 * * * 1.1 1.1 1.3 *1.9 *2.2 *1.7

(0.2) ... ... ... (0.3) (0.2) (0.3) (0.6) (0.9) (0.5)

6.2 6.5 5.1 6.9 7.6 8.9 14.8 17.1 17.9 16.6

(0.9) (1.9) (0.8) (0.9) (0.7) (0.7) (1.0) (1.0) (1.3) (1.2)

31.1 31.7 31.8 30.3 40.1 42.8 45.3 53.0 50.3 54.9

(1.5) (2.3) (1.9) (2.0) (1.5) (1.3) (1.3) (1.6) (1.8) (1.9)

47.0 46.5 47.4 46.8 39.8 37.0 30.3 21.8 23.2 20.9

(1.6) (2.6) (2.0) (1.9) (1.3) (1.0) (1.2) (1.4) (1.5) (1.6)

13.1 13.1 13.3 13.0 9.0 8.0 6.1 3.7 4.0 3.6

(1.5) (2.0) (1.5) (1.6) (1.0) (0.9) (0.7) (0.6) (0.7) (0.6)

*1.9 * *1.5 *2.3 *2.4 *2.1 *2.2 *2.4 *2.4 *2.4

(0.7) ... (0.6) (0.8) (1.0) (0.8) (0.8) (0.9) (1.0) (0.9)

Female Male

74,621 61,676

100.0 100.0

0.9 1.6

(0.2) (0.3)

10.1 11.4

(0.7) (0.7)

44.2 40.0

(1.3) (1.0)

35.0 36.2

(1.2) (0.9)

7.6 8.6

(0.7) (0.8)

*2.2 *2.1

(0.8) (0.8)

Race2,3 White Black or African American Other

98,147 32,627 5,523

100.0 100.0 100.0

1.3 1.0 *

(0.3) (0.2) ...

11.2 9.4 9.2

(0.7) (0.8) (1.3)

42.5 41.6 43.4

(1.3) (1.4) (2.6)

34.6 38.3 35.9

(1.1) (1.5) (2.2)

8.0 8.5 6.7

(0.8) (0.9) (1.3)

*2.4 *1.3 *3.8

(0.9) (1.1) (2.6)

19,206 117,091 81,185 31,514 4,392

100.0 100.0 100.0 100.0 100.0

0.8 1.3 1.4 1.0 *

(0.2) (0.3) (0.3) (0.2) ...

9.3 10.9 11.6 9.6 9.3

(1.0) (0.7) (0.8) (0.8) (1.3)

41.4 42.5 42.8 41.4 44.8

(2.0) (1.2) (1.4) (1.5) (2.9)

37.2 35.3 34.2 38.3 34.5

(1.7) (1.0) (1.2) (1.6) (2.2)

10.0 7.7 7.6 8.4 5.9

(1.4) (0.7) (0.8) (0.9) (1.2)

*1.3 *2.3 *2.5 *1.4 *4.5

(1.0) (0.8) (0.9) (1.2) (3.2)

47,600 43,327 25,060 5,771 21,744 1,503 5,592 7,867

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

1.3 0.8 1.7 * 1.4 * * *

(0.4) (0.2) (0.5) ... (0.3) ... ... ...

11.9 9.6 16.4 16.3 9.2 * 10.3 7.5

(0.7) (0.9) (1.0) (1.7) (0.8) ... (1.1) (1.3)

45.3 38.7 50.2 46.8 39.7 22.1 44.5 42.2

(1.4) (1.3) (1.4) (2.2) (1.3) (3.0) (2.6) (2.5)

32.6 38.4 24.8 27.0 39.2 57.7 37.1 37.3

(1.1) (1.4) (1.4) (2.2) (1.2) (3.5) (1.6) (2.1)

6.8 9.8 4.4 5.3 8.7 * 6.4 10.1

(0.8) (1.0) (0.5) (0.8) (1.0) ... (1.3) (1.3)

*2.2 *2.6 *2.6 *3.4 *1.9 * * *

(0.8) (1.1) (1.1) (1.8) (0.8) ... ... ...

Sex

Ethnicity and race2,3 Hispanic or Latino Not Hispanic or Latino White Black or African American Other Expected source(s) of payment4 Private insurance Medicaid or CHIP5 Medicare Medicare and Medicaid6 No insurance7 Workers' compensation Other Unknown or blank

...Category not applicable. *Figure does not meet standards of reliability or precision. 1

A visit which occurred in an emergency service area that does not conduct nursing triage.

2

The race groups, white, black or African American, and other include persons of Hispanic and not Hispanic origin. Persons of Hispanic origin may be of any race. For 2011, race data were missing for 14.8 percent of visits, and ethnicity data were missing for 18.5 percent of visits. The National Center for Health Statistics uses model-based single imputation for NHAMCS race and ethnicity data. The race imputation is restricted to three categories (white, black, and other) based on research by an internal work group and on quality concerns with imputed estimates for race categories other than white and black. The imputation technique is described in more detail in the 2011 NHAMCS Public Use Data File documentation, available at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHAMCS/doc11.pdf. 3

Other race includes the categories of Asian, Native Hawaiian or other Pacific Islander, American Indian or Alaska Native, and persons with more than one race.

4

Total exceeds "all visits" because more than one source of payment may be reported per visit.

5

CHIP is the Children's Health Insurance Program.

6

The visits in this category are also included in both the Medicare and the Medicaid or CHIP categories.

7

"No insurance" is defined as having only self-pay, no charge, or charity as payment sources. The individual self-pay and no-charge or charity categories are not mutually exclusive. NOTES: The 2011 Patient Record Form (PRF) requested responses using a 1–5 scale. PRF responses were evaluated with reference to responses on the Ambulatory Unit Record, completed during induction, to the question, “How many levels are in this emergency service area’s (ESA) triage system?” ESAs using 3 or 4 level triage systems had their responses rescaled to fit the 5 level system, such that, for 3-level ESAs, responses of 1, 2, and 3 were recoded to 2, 3, and 4. For ESAs using a 4–level system, responses were recoded from 1–4 to 2–5. The rescaling method was determined in consultation with subject matter experts and based on record analysis. Rescaling was required for about 12.0 percent of records. Also, missing responses (17.9%) were imputed to levels 1–5 using a hot deck (i.e. current year’s data) to identify donor records. Matching was based on the number of levels in the ESA's triage system, 3–digit ICD–9–CM code for primary diagnosis, the hospital's ED volume, and geographic region. This is unlike years 2005–2008 when "no triage" and "unknown," checkboxes used on the PRF in those years, were also valid imputation categories. Numbers may not add to totals because of rounding. SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

Table 8. Initial blood pressure measurements recorded at emergency department visits by adults 18 years and over, by selected patient characteristics: United States, 2011 Initial blood pressure1 Patient characteristics All visits2

Number of visits in thousands

Total

SBP100 mm Hg 17.8

(0.5)

(0.9) (0.7) (0.8) (1.4) (1.3)

4.4 12.9 23.6 27.7 31.4

(0.4) (0.5) (0.8) (1.6) (1.1)

25.2 31.5

(0.6) (0.6)

16.8 19.1

(0.6) (0.7)

(0.5) (1.0) (1.7)

28.3 27.0 26.4

(0.5) (0.8) (1.5)

17.3 20.0 13.1

(0.5) (1.0) (1.6)

(1.1) (0.5) (0.5) (1.0) (1.7)

27.2 28.0 28.4 27.0 27.2

(1.1) (0.4) (0.5) (0.8) (1.7)

12.9 18.4 18.0 20.3 14.7

(0.8) (0.5) (0.5) (1.0) (1.5)

Age 18–24 years 25–44 years 45–64 years 65–74 years 75 years and over Sex

1

SBP is systolic blood pressure. DBP is diastolic blood pressure. Three high blood pressure categories (SBP>120 or DBP>80) are based on the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC–7) and correspond to prehypertensive, stage 1 hypertensive, and stage 2 hypertensive ranges. If the SBP and DBP taken fall into two differnt categories, the visit is included in the higher blood pressure category.

2

Visits by adults (18 years of age or over). Visits where blood pressure was taken represent 97.0 percent (SE=0.7) of all emergency department visits made by adults. The race groups, white, black or African American, and other include persons of Hispanic and not Hispanic origin. Persons of Hispanic origin may be of any race. For 2011, race data were missing for 14.8 percent of visits, and ethnicity data were missing for 18.5 percent of visits. The National Center for Health Statistics uses model-based single imputation for NHAMCS race and ethnicity data. The race imputation is restricted to three categories (white, black, and other) based on research by an internal work group and on quality concerns with imputed estimates for race categories other than white and black. The imputation technique is described in more detail in the 2011 NHAMCS Public Use Data File documentation, available at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHAMCS/doc11.pdf. 3

4

Other race includes the categories of Asian, Native Hawaiian or other Pacific Islander, American Indian or Alaska Native, and persons with more than one race. NOTE: Numbers may not add to totals because of rounding. SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

Table 9. Initial temperature, pulse oximetry, and visit history at emergency department visits: United States, 2011 Number of visits in thousands (standard Percent distribution Visit characteristic error in thousands) (standard error of percent) All visits 136,296 (6,413) 100.0 ... Temperature Febrile: greater than 38.0o C or greater than 100.4oF Normal: 35.1–38.0o C or 95.1–100.4oF Hypothermic: 35.0o C or less, or 95.0oF or less Blank

5,328 124,430 431 6,107

(373) (5,964) (59) (898)

3.9 91.3 0.3 4.5

(0.2) (0.6) (0.0) (0.6)

113,292 9,140 13,864

(5,704) (914) (1,525)

83.1 6.7 10.2

(1.2) (0.6) (1.0)

Initial visit Follow-up visit Unknown or blank

116,825 6,891 12,581

(5,911) (448) (2,124)

85.7 5.1 9.2

(1.5) (0.2) (1.5)

Patient seen in this emergency department within the last 72 hours Yes No Unknown or blank

5,396 107,225 23,674

(572) (5,569) (3,107)

4.0 78.7 17.4

(0.4) (2.0) (2.1)

Pulse oximetry1 95–100% Less than 95% Blank Episode of care

...Category not applicable. 0.0 Quantity more than zero but less than 0.05. 1

Normal oxygen saturation as measured by pulse oximetry is 95% or more. NOTE: Numbers may not add to totals because of rounding. SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

Table 10. Ten leading principal reasons for emergency department visits, by patient age and sex: United States, 2011 Principal reason for visit and RVC code1 All visits Stomach and abdominal pain, cramps and spasms Chest pain and related symptoms (not referable to body systems) Fever Headache, pain in head Cough Back symptoms Shortness of breath Pain, site not referable to a specific body system Symptoms referable to throat Vomiting All other reasons2 All visits under age 15 Female: Fever Cough Stomach and abdominal pain, cramps and spasms Vomiting Skin rash Earache, or ear infection Symptoms referable to throat Injury, other and unspecified type-head, neck, and face Laceration or cut of facial area Headache, pain in head All other reasons2 Male: Fever Cough Vomiting Injury, other and unspecified type-head, neck, and face Skin rash Stomach and abdominal pain, cramps and spasms Earache, or ear infection Laceration or cut of facial area Symptoms referable to throat Headache, pain in head All other reasons2 All visits, age 15-64 years Female: Stomach and abdominal pain, cramps and spasms Chest pain and related symptoms (not referable to body systems) Headache, pain in head

... S545 S050 S010 S210 S440 S905 S415 S055 S455 S530 ... ... ... S010 S440 S545 S530 S860 S355 S455 J505 J210 S210 ... ... S010 S440 S530 J505 S860 S545 S355 J210 S455 S210 ... ... ... S545 S050 S210

Number of visits in thousands (standard error in thousands) 136,296 (6,413) 11,069 (618) 7,052 (454) 5,077 (382) 4,323 (366) 4,056 (274) 3,880 (288) 3,700 (304) 3,012 (218) 2,563 (201) 2,458 (191) 89,106 (4,175) 24,823 (1,724) 11,385 (820) 1,831 (200) 836 (114) 583 (75) 444 (53) 413 (63) 374 (48) 325 (51) 295 (54) 228 (52) 213 (47) 5,844 (423) 13,439 (945) 1,969 (169) 1,043 (106) 573 (77) 543 (85) 464 (62) 452 (70) 397 (52) 383 (66) 310 (51) 242 (44) 7,062 (581) 91,101 (4,430) 51,204 (2,587) 6,163 (389) 2,679 (209) 2,331 (225)

Percent distribution (standard error of percent) 100.0 ... 8.1 (0.2) 5.2 (0.2) 3.7 (0.2) 3.2 (0.2) 3.0 (0.2) 2.8 (0.1) 2.7 (0.2) 2.2 (0.1) 1.9 (0.1) 1.8 (0.1) 65.4 (0.5) 100.0 ... 45.9 (0.8) 7.4 (0.6) 3.4 (0.4) 2.4 (0.3) 1.8 (0.2) 1.7 (0.2) 1.5 (0.2) 1.3 (0.2) 1.2 (0.2) 0.9 (0.2) 0.9 (0.2) 23.5 (0.7) 54.1 (0.8) 7.9 (0.5) 4.2 (0.4) 2.3 (0.3) 2.2 (0.3) 1.9 (0.2) 1.8 (0.2) 1.6 (0.2) 1.5 (0.2) 1.3 (0.2) 1.0 (0.2) 28.4 (0.9) 100.0 ... 56.2 (0.5) 6.8 (0.3) 2.9 (0.2) 2.6 (0.2)

Back symptoms Problems of pregnancy Pain, site not referable to a specific body system Shortness of breath Symptoms referable to throat Cough Symptoms of teeth and gums All other reasons2 Male: Stomach and abdominal pain, cramps and spasms Chest pain and related symptoms (not referable to body systems) Back symptoms Headache, pain in head Pain, site not referable to a specific body system Laceration or cut of upper extremity Shortness of breath Symptoms of teeth and gums Cough Leg symptoms All other reasons2 All visits, age 65 years and over Female: Shortness of breath Chest pain and related symptoms (not referable to body systems) Stomach and abdominal pain, cramps and spasms General weakness Back symptoms Hip symptoms Accident, not otherwise specified Leg symptoms Vertigo-dizziness Headache, pain in head All other reasons2 Male: Chest pain and related symptoms (not referable to body systems) Shortness of breath Stomach and abdominal pain, cramps and spasms Vertigo-dizziness General weakness Leg symptoms Accident, not otherwise specified Laceration or cut of upper extremity Pain, site not referable to a specific body system Other urinary dysfunctions All other reasons2

S905 S790 S055 S415 S455 S440 S500 ... ... S545 S050 S905 S210 S055 J225 S415 S500 S440 S920 ... ... ... S415 S050 S545 S020 S905 S915 J810 S920 S225 S210 ... ... S050 S415 S545 S225 S020 S920 J810 J225 S055 S660 ...

1,838 1,470 1,387 1,229 1,176 1,045 880 31,006 39,897 2,649 2,627 1,461 1,179 1,150 1,147 826 791 765 726 26,578 20,372 12,032 861 854 746 376 352 335 333 327 307 277 7,262 8,340 748 611 475 366 287 203 * 163 156 155 5,005

(154) (141) (127) (130) (120) (116) (123) (1,505) (1,950) (193) (180) (130) (126) (111) (101) (101) (95) (90) (85) (1,306) (1,172) (731) (95) (98) (85) (54) (67) (62) (77) (50) (48) (55) (450) (508) (99) (71) (58) (55) (43) (38) ... (38) (34) (33) (360)

2.0 1.6 1.5 1.3 1.3 1.1 1.0 34.0 43.8 2.9 2.9 1.6 1.3 1.3 1.3 0.9 0.9 0.8 0.8 29.2 100.0 59.1 4.2 4.2 3.7 1.8 1.7 1.6 1.6 1.6 1.5 1.4 35.6 40.9 3.7 3.0 2.3 1.8 1.4 1.0 * 0.8 0.8 0.8 24.6

(0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.4) (0.5) (0.2) (0.2) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.4) ... (1.0) (0.4) (0.4) (0.4) (0.3) (0.3) (0.3) (0.3) (0.2) (0.2) (0.2) (0.9) (1.0) (0.4) (0.3) (0.3) (0.3) (0.2) (0.2) ... (0.2) (0.2) (0.2) (1.0)

...Category not applicable. * Figure does not meet standards of reliability or precision. 1

Based on A Reason for Visit Classification (RVC) for Ambulatory Care, National Center for Health Statistics. Vital Health Stat 2(78) 1979. See 2011 National Hospital Ambulatory Medical Care Survey Public Use File Documentation (ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documention/NHAMCS/doc11.pdf). Reason for visit is defined by patient's own words. 2

Category includes all other reasons not listed above, as well as unknown and blanks. NOTE: Numbers may not add to totals because of rounding. SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

Table 11. Primary diagnosis at emergency department visits, classified by major disease category: United States, 2011

Major disease category and ICD–9–CM code range1 All visits Infectious and parasitic diseases Neoplasms Endocrine, nutritional, metabolic diseases, and immunity disorders Mental disorders Diseases of the nervous system and sense organs Diseases of the circulatory system Diseases of the respiratory system Diseases of the digestive system Diseases of the genitourinary system Diseases of the skin and subcutaneous tissue Diseases of the musculoskeletal system and connective tissue Symptoms, signs, and ill-defined conditions Injury and poisoning Fractures Sprains and strains Intracranial injury Open wounds Superficial injury Contusion with intact skin surface Foreign bodies Burns Trauma complications and unspecified injuries Poisoning and toxic effects Surgical and medical complications Other injuries Supplementary classification2 All other diagnoses3 Unknown or blank

... 001–139 140–239 240–279 290–319 320–389 390–459 460–519 520–579 580–629 680–709 710–739 780–799 800–999 800–829 840–848 850–854 870–897 910–919 920–924 930–939 940–949 958–959 960–989 996–999 ... V01–V89 ... ...

Number of visits in thousands (standard error in thousands) 136,296 (6,413) 3,966 (269) 284 (53) 2,071 (161) 5,315 (371) 6,419 (411) 4,359 (307) 13,464 (730) 7,681 (463) 7,175 (441) 5,305 (327) 9,256 (572) 30,740 (1,699) 30,664 (1,564) 4,087 (269) 6,279 (410) 537 (79) 6,359 (387) 1,689 (122) 4,646 (279) 574 (74) 486 (67) 2,567 (213) 989 (110) 548 (75) 1,904 (152) 3,718 (238) 5,419 (442) 462 (80)

Percent distribution (standard error of percent) 100.0 ... 2.9 (0.2) 0.2 (0.0) 1.5 (0.1) 3.9 (0.2) 4.7 (0.2) 3.2 (0.2) 9.9 (0.4) 5.6 (0.2) 5.3 (0.2) 3.9 (0.2) 6.8 (0.3) 22.6 (0.6) 22.5 (0.5) 3.0 (0.2) 4.6 (0.2) 0.4 (0.1) 4.7 (0.2) 1.2 (0.1) 3.4 (0.2) 0.4 (0.0) 0.4 (0.0) 1.9 (0.1) 0.7 (0.1) 0.4 (0.0) 1.4 (0.1) 2.7 (0.1) 4.0 (0.2) 0.3 (0.1)

....Category not applicable. 0.0 Quantity more than zero but less than 0.05. 1

Based on the International Classification of Diseases. Ninth Revision, Clinical Modification (ICD–9–CM)(U.S. Department of Health Services. Centers for Medicare and Medicaid Service. Official version: International Classification of Diseases, Ninth Revision, Clinical Modification, Sixth Edition. DHHS Pub No.(PHS)06–1260). However, certain codes have been combined in this table to better describe the utilization of ambulatory care services. 2

Incudes general medical examination, routine prenatal examination, and health supervision of an infant or child, and other diagnoses not classifiable to injury or illness.

3

Includes diseases of the blood and blood-forming organs (280–289); complications of pregnancy, childbirth, and the puerperium (630–679); congenital anomalies (740–759), certain conditions originating in perinatal period (760–779), entries not codable to the ICD–9–CM (e.g., illegible entries, patient left before been seen, patient was transferred to another facility, health maintenance organization did not authorize treatment, and entries of, "none," "no diagnosis," or "no disease"). NOTE: Numbers may not add to totals because of rounding. SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

Table 12. Twenty leading primary diagnosis groups and presence of chronic conditions at emergency department visits: United States, 2011 Primary diagnosis group with ICD–9–CM code(s) and chronic condition All visits

---



1

Primary diagnosis group with ICD–9–CM code(s) Abdominal pain Chest pain Contusion with intact skin surface Acute upper respiratory infections, excluding pharyngitis Spinal disorders Open wound, excluding head Cellulitis and abscess Sprains and strains, excluding ankle and back Fractures, excluding lower limb Rheumatism, excluding back Headache Urinary tract infection, site not specified Open wound of head Arthropathies and related disorders Sprains and strains of neck and back Diseases of the teeth and supporting structures Pyrexia of unknown origin Otitis media and eustachian tube disorders Complications of pregnancy, childbirth, and the puerperium Asthma All other diagnoses2

Chronic condition3 Diabetes Congestive heart failure Cerebrovascular disease or history of stroke or transient ischemic attack (TIA) Condition requiring dialysis HIV4 None of the above Blank

789.0 786.5 920–924 460–461,463–466 720–724 874–897 681–682 840–844,845.1,848 800–819 725–729 784.0 599.0 870–873 710–719 846,847 520–525 780.6 381–382 630–679.99 493 ...

6,911 5,521 4,646 4,625 4,260 4,089 3,262 2,838 2,745 2,500 2,378 2,342 2,269 2,206 2,186 1,927 1,852 1,851 1,790 1,781 74,316

(472) (420) (279) (316) (302) (255) (227) (229) (200) (204) (268) (180) (193) (182) (173) (190) (160) (153) (198) (156) (3,515)

5.1 4.1 3.4 3.4 3.1 3.0 2.4 2.1 2.0 1.8 1.7 1.7 1.7 1.6 1.6 1.4 1.4 1.4 1.3 1.3 54.5

(0.2) (0.2) (0.2) (0.2) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.2) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.5)

---------------

11,667 4,221 4,071 1,269 526 109,168 8,942

(748) (322) (547) (147) (73) (5,134) (808)

8.6 3.1 3.0 0.9 0.4 80.1 6.6

(0.3) (0.2) (0.4) (0.1) (0.1) (0.6) (0.5)

....Category not applicable. 1

Based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD–9–CM) (U.S. Department of Health and Human Services. Centers for Medicare and Medicaid Services. Official version International Classification of Diseases, Ninth Revision, Clinical Modification, Sixth Edition. DHHS Pub No. (PHS) 06–1260). 2

Includes all other diagnoses not listed above as well as unknown and blanks.

3

Presence of chronic conditions was based on the checklist of chronic conditions and reported diagnoses. Combined total of visits by patients with chronic conditions and percent of visits exceeds 100% because more than one chronic condition may be reported per visit. 4

HIV is human immunodeficiency virus. NOTE: Numbers may not add to totals because of rounding. SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

Table 13. Twenty leading primary diagnosis groups for emergency department visits, by patient age and sex: United States, 2011 Principal diagnosis group and ICD–9–CM code(s)1 All visits All visits, age under 15 years Female: Acute upper respiratory infections, excluding pharyngitis Pyrexia of unknown origin Otitis media and eustachian tube disorders Contusion with intact skin surface Open wound of head Abdominal pain Acute pharyngitis Open wound, excluding head Unspecified viral and chlamydial infection Fractures, excluding lower limb Sprains and strains, excluding ankle and back Conjunctivitis Asthma Urinary tract infection, site not specified Streptococcal sore throat Cellulitis and abscess Superficial injuries Observation and evaluation for suspected conditions not found Sprains and strains of ankle Pneumonia All other diagnoses2 Male: Acute upper respiratory infections, excluding pharyngitis Otitis media and eustachian tube disorders Pyrexia of unknown origin Open wound of head Contusion with intact skin surface Fractures, excluding lower limb Open wound, excluding head Asthma Acute pharyngitis Unspecified viral and chlamydial infection Superficial injuries Abdominal pain Streptococcal sore throat Sprains and strains, excluding ankle and back Pneumonia Cellulitis and abscess Cough

Number of visits in thousands (standard error in thousands) ... 136,296 (6,413) ... ... 460–461,463–466 780.6 381–382 920–924 870–873 789.0 462 874–897 079.9 800–819 840–844,845.1,848 372.0–372.3 493 599.0 034.0 681–682 910–919 V71 845.0 480–486 ... ... 460–461,463–466 381–382 780.6 870–873 920–924 800–819 874–897 493 462 079.9 910–919 789.0 034.0 840–844,845.1,848 480–486 681–682 786.2

24,823 11,385 1,003 646 625 441 383 331 299 291 280 258 255 226 215 214 187 185 180 160 * 128 4,931 13,439 1,283 746 727 683 614 445 397 396 308 288 271 230 227 220 201 186 180

(1,724) (820) (126) (98) (72) (60) (78) (56) (59) (47) (59) (50) (48) (44) (51) (38) (41) (37) (37) (30) ... (33) (376) (945) (121) (81) (73) (96) (89) (78) (56) (65) (54) (50) (42) (41) (57) (50) (41) (37) (47)

Percent distribution (standard error of percent) 100.0 ... 100.0 45.9 4.0 2.6 2.5 1.8 1.5 1.3 1.2 1.2 1.1 1.0 1.0 0.9 0.9 0.9 0.8 0.7 0.7 0.6 * 0.5 19.9 54.1 5.2 3.0 2.9 2.8 2.5 1.8 1.6 1.6 1.2 1.2 1.1 0.9 0.9 0.9 0.8 0.7 0.7

... (0.8) (0.4) (0.3) (0.2) (0.2) (0.3) (0.2) (0.2) (0.2) (0.2) (0.2) (0.2) (0.2) (0.2) (0.1) (0.2) (0.1) (0.1) (0.1) ... (0.1) (0.7) (0.8) (0.4) (0.3) (0.3) (0.3) (0.4) (0.3) (0.2) (0.2) (0.2) (0.2) (0.2) (0.2) (0.2) (0.2) (0.2) (0.1) (0.2)

Conjunctivitis Chronic and unspecified bronchitis Noninfectious enteritis and colitis All other diagnoses2 All visits, age 15–64 years Female: Abdominal pain Chest pain Spinal disorders Complications of pregnancy, childbirth, and the puerperium Contusion with intact skin surface Urinary tract infection, site not specified Headache Acute upper respiratory infections, excluding pharyngitis Cellulitis and abscess Rheumatism, excluding back Sprains and strains, excluding ankle and back Open wound, excluding head Sprains and strains of neck and back Diseases of the teeth and supporting structures Arthropathies and related disorders Asthma Migraine Noninflammatory disorders of the female genital organs Superficial injuries Sprains and strains of ankle All other diagnoses2 Male: Chest pain Open wound, excluding head Abdominal pain Spinal disorders Contusion with intact skin surface Cellulitis and abscess Fractures, excluding lower limb Sprains and strains, excluding ankle and back Sprains and strains of neck and back Drug dependence and nondependence abuse of drugs Diseases of the teeth and supporting structures Rheumatism, excluding back Arthropathies and related disorders Acute upper respiratory infections, excluding pharyngitis Psychoses, excluding major depressive disorder Open wound of head Headache Superficial injuries

372.0–372.3 490–491 555–558 ...

179 173 168 5,517

(42) (43) (34) (456)

0.7 0.7 0.7 22.2

(0.2) (0.2) (0.1) (0.7)

... ... 789.0 786.5 720–724 630–679.99 920–924 599.0 784.0 460–461,463–466 681–682 725–729 840–844,845.1,848 874–897 846,847 520–525 710–719 493 346 620,622–624 910–919 845.0 ... ... 786.5 874–897 789.0 720–724 920–924 681–682 800–819 840–844,845.1,848 846,847 304–305 520–525 725–729 710–719 460–461,463–466 290–295,296.0–296.1,296.4– 870–873 784.0 910–919

91,101 51,204 3,879 2,067 1,965 1,790 1,569 1,415 1,322 1,304 1,267 1,218 1,128 1,025 948 932 814 772 681 642 586 585 25,297 39,897 2,139 1,885 1,679 1,669 1,320 1,293 1,149 1,015 946 884 835 800 762 749 728 690 627 518

(4,430) (2,587) (324) (189) (163) (198) (148) (130) (152) (121) (108) (113) (117) (97) (86) (115) (100) (84) (81) (80) (65) (68) (1,270) (1,950) (169) (137) (148) (151) (100) (113) (104) (111) (95) (108) (106) (93) (83) (78) (81) (71) (96) (59)

100.0 56.2 4.3 2.3 2.2 2.0 1.7 1.6 1.5 1.4 1.4 1.3 1.2 1.1 1.0 1.0 0.9 0.8 0.7 0.7 0.6 0.6 27.8 43.8 2.3 2.1 1.8 1.8 1.4 1.4 1.3 1.1 1.0 1.0 0.9 0.9 0.8 0.8 0.8 0.8 0.7 0.6

... (0.5) (0.3) (0.1) (0.1) (0.2) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.5) (0.5) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1) (0.1)

Calculus of kidney and ureter Acute pharyngitis All other diagnoses2 All visits, age 65 years and over Female: Chest pain Abdominal pain Heart disease, excluding ischemic Contusion with intact skin surface Pneumonia Urinary tract infection, site not specified Spinal disorders Fracture of the lower limb Arthropathies and related disorders Fractures, excluding lower limb Chronic and unspecified bronchitis Cerebrovascular disease Open wound, excluding head Essential hypertension Dyspnea and respiratory abnormalities Rheumatism, excluding back Acute upper respiratory infections, excluding pharyngitis Dizziness and giddiness Cellulitis and abscess Headache All other diagnoses2 Male: Chest pain Heart disease, excluding ischemic Open wound, excluding head Abdominal pain Syncope and collapse Contusion with intact skin surface Pneumonia Dyspnea and respiratory abnormalities Urinary tract infection, site not specified Cellulitis and abscess Symptoms involving the urinary system Cerebrovascular disease Spinal disorders Chronic and unspecified bronchitis Fractures, excluding lower limb Dizziness and giddiness Arthropathies and related disorders

592 462 ...

416 414 19,379

(68) (56) (1,013)

0.5 0.5 21.3

(0.1) (0.1) (0.4)

... ... 786.5 789.0 391–392.0,393–398,402,404, 415–416,420–429 920–924 480–486 599.0 720–724 820–829 710–719 800–819 490–491 430–438 874–897 401 786.0 725–729 460–461,463–466 780.4 681–682 784.0 ... ... 786.5 391–392.0,393–398,402,404, 415–416,420–429 874–897 789.0 780.2 920–924 480–486 786.0 599.0 681–682 788 430–438 720–724 490–491 800–819 780.4 710–719

20,372 12,032 604 528 485

(1,172) (731) (92) (59) (65)

100.0 59.1 3.0 2.6 2.4

... (1.0) (0.4) (0.3) (0.3)

461 401 352 344 339 326 301 285 224 221 220 206 202 182 182 159 * 5,856 8,340 612 435

(54) (64) (60) (58) (60) (55) (40) (42) (39) (40) (48) (40) (41) (44) (35) (30) ... (376) (508) (90) (55)

2.3 2.0 1.7 1.7 1.7 1.6 1.5 1.4 1.1 1.1 1.1 1.0 1.0 0.9 0.9 0.8 * 28.7 40.9 3.0 2.1

(0.3) (0.3) (0.3) (0.3) (0.3) (0.3) (0.2) (0.2) (0.2) (0.2) (0.2) (0.2) (0.2) (0.2) (0.2) (0.1) ... (0.8) (1.0) (0.4) (0.2)

270 265 254 241 222 195 180 173 164 156 149 148 143 * *

(52) (46) (49) (46) (37) (34) (42) (35) (32) (35) (27) (27) (35) ... ...

1.3 1.3 1.2 1.2 1.1 1.0 0.9 0.9 0.8 0.8 0.7 0.7 0.7 * *

(0.3) (0.2) (0.2) (0.2) (0.2) (0.2) (0.2) (0.2) (0.2) (0.2) (0.1) (0.1) (0.2) ... ...

Essential hypertension Anemias Acute upper respiratory infections, excluding pharyngitis All other diagnoses2

401 280–285 460–461,463–466 ...

* * * 4,170

... ... ... (279)

* * * 20.5

... ... ... (0.8)


Based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD–9–CM) (U.S. Department of Health Services. Centers for Medicare and Medicaid Service. Official version: International Classification of Diseases, Ninth Revision, Clinical Modification, Sixth Edition. DHHS Pub No.(PHS) 06–1260). However, certain codes have been combined in this table to better describe the use of ambulatory care services. 2

Includes all other diagnoses not listed above as well as unknown and blanks. NOTE: Numbers may not add to totals because of rounding. SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

Table 14. Injury visits to emergency departments, by selected patient and hospital characteristics: United States, 2011 Number of visits per Selected patient and hospital Number of visits in thousands Percent distribution 100 persons per year1 characteristics (standard error in thousands) (standard error of percent) (standard error of rate) 40,220 (2,071) 100.0 ... 13.1 (0.7) All injury visits2 Patient characteristics Age: Under 15 years Under 1 year 1–4 years 5–14 years 15–24 years 25–44 years 45–64 years 65 years and over 65–74 years 75 years and over

8,068 489 2,862 4,717 7,253 11,368 8,331 5,201 1,940 3,261

(644) (71) (233) (427) (406) (629) (453) (337) (163) (239)

20.1 1.2 7.1 11.7 18.0 28.3 20.7 12.9 4.8 8.1

(1.0) (0.2) (0.5) (0.7) (0.5) (0.7) (0.6) (0.5) (0.3) (0.4)

13.2 12.2 17.7 11.5 16.9 14.2 10.2 13.0 8.7 18.3

(1.1) (1.8) (1.4) (1.0) (0.9) (0.8) (0.6) (0.8) (0.7) (1.3)

Sex and age Female Under 15 years 15–24 years 25–44 years 45–64 years 65–74 years 75 years and over Male Under 15 years 15–24 years 25–44 years 45–64 years 65–74 years 75 years and over

18,952 3,459 3,081 5,202 4,011 1,064 2,134 21,268 4,608 4,172 6,166 4,320 876 1,127

(1,029) (277) (204) (334) (259) (112) (165) (1,144) (418) (259) (386) (260) (93) (114)

47.1 8.6 7.7 12.9 10.0 2.6 5.3 52.9 11.5 10.4 15.3 10.7 2.2 2.8

(0.8) (0.5) (0.3) (0.5) (0.4) (0.2) (0.3) (0.8) (0.7) (0.4) (0.7) (0.4) (0.2) (0.2)

12.1 11.6 14.5 12.7 9.5 8.9 20.0 14.2 14.7 19.3 15.6 10.9 8.5 15.7

(0.7) (0.9) (1.0) (0.8) (0.6) (0.9) (1.5) (0.8) (1.3) (1.2) (1.0) (0.7) (0.9) (1.6)

28,593 7,392 4,235

(1,991) (1,096) (1,117)

71.1 18.4 10.5

(3.4) (2.7) (2.6)

9.3 2.4 1.4

(0.6) (0.4) (0.4)

7,294 8,935 15,251 8,740

(776) (812) (1,349) (1,043)

18.1 22.2 37.9 21.7

(1.8) (1.9) (2.5) (2.2)

13.3 13.5 13.4 12.2

(1.4) (1.2) (1.2) (1.5)

33,635 6,585

(2,041) (873)

83.6 16.4

(2.1) (2.1)

13.1 13.4

(0.8) (1.8)

Hospital characteristics Ownership Voluntary Proprietary Government Geographic region Northeast Midwest South West Metropolitan status3 Metropolitan statistical area Nonmetropolitan statistical area ...Category not applicable. 1

Visit rates for age, sex, race, and region are based on the July 1, 2011, set of estimates of the civilian noninstitutional population of the United States as developed by the Population Division, U.S. Census Bureau. 2

The National Hospital Ambulatory Medical Care Survey definition of injury visits, as shown on this table, changed in 2010 and includes first-, second-, and third-listed reason for visit and diagnosis codes that are injury or poison related. Adverse effects and complications are excluded. Reason for visit was coded using A Reason for Visit Classification for Ambulatory Care; diagnosis and external cause of injury were coded using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM) (U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. Official version International Classification of Diseases, Ninth Revision, Clinical Modification, Sixth Edition. DHHS Pub No.(PHS) 06–1260). Injury visits, using this definition, accounted for 29.5 percent (SE=0.6) of all emergency department visits in 2011. For more details see the 2011 NHAMCS Public Use Data File documentation, available at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHAMCS/doc11.pdf. 3

Population estimates by metropolitan statistical area status are based on estimates of the civilian noninstitutionalized population of United States as of July1, 2011, from the 2011 National Health Interview Survey, National Center for Health Statistics, compiled according to December 2009 Office of Management and Budget definition of core-based statistical areas. See http://www.census.gov/population/metro/ for more about metropolitan statistical area definitions. NOTE: Numbers may not add to totals because of rounding. SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

Table 15. Injury visits to emergency departments by race and age, and ethnicity: United States, 2011

Patient characteristics All injury visits2 Race and age3,4 White Under 15 years 15–24 years 25–44 years 45–64 years 65–74 years 75 years and over Black or African American Under 15 years 15–24 years 25–44 years 45–64 years 65–74 years 75 years and over Other



Number of visits per 100 persons per year (standard error of rate)1 13.1 (0.7)

30,522 5,757 5,271 8,516 6,486 1,603 2,890 8,016 1,814 1,698 2,366 1,576 275 287 1,682

(1,710) (499) (359) (505) (387) (137) (211) (619) (221) (145) (233) (152) (66) (83) (239)

75.9 14.3 13.1 21.2 16.1 4.0 7.2 19.9 4.5 4.2 5.9 3.9 0.7 0.7 4.2

(1.4) (0.8) (0.6) (0.7) (0.5) (0.3) (0.4) (1.2) (0.5) (0.3) (0.5) (0.3) (0.2) (0.2) (0.6)

12.7 12.8 16.5 13.8 9.7 8.5 18.5 20.4 19.7 25.9 22.6 16.4 13.2 20.6 6.2

(0.7) (1.1) (1.1) (0.8) (0.6) (0.7) (1.3) (1.6) (2.4) (2.2) (2.2) (1.6) (3.2) (6.0) (0.9)

5,375 34,845 25,845 7,704 1,295

(555) (1,756) (1,452) (594) (188)

13.4 86.6 64.3 19.2 3.2

(1.1) (1.1) (1.5) (1.2) (0.5)

10.5 13.7 13.3 20.8 5.5

(1.1) (0.7) (0.7) (1.6) (0.8)

Ethnicity and race3,4 Hispanic Not Hispanic White Black or African American Other ...Category not applicable. 1

Visit rates are based on the July 1, 2011, estimates of the civilian noninstitutional population of the United States as developed by the Population Division, U.S. Census Bureau.

2

The National Hospital Ambulatory Medical Care Survey definition of injury visits, as shown on this table, changed in 2010 and includes first-, second-, and third-listed reason for visit and diagnosis codes that are injury or poison related. Adverse effects and complications are excluded. Reason for visit was coded using A Reason for Visit Classification for Ambulatory Care; diagnosis and external cause of injury were coded using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM) (U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. Official version International Classification of Diseases, Ninth Revision, Clinical Modification, Sixth Edition. DHHS Pub No.(PHS) 06–1260). Injury visits, using this definition, accounted for 29.5 percent (SE=0.6) of all emergency department visits in 2011. For more details see the 2011 NHAMCS Public Use Data File documentation, available at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHAMCS/doc11.pdf. 3

The race groups, white, black or African American, and other include persons of Hispanic and not Hispanic origin. Persons of Hispanic origin may be of any race. For 2011, race data were missing for 14.8 percent of visits, and ethnicity data were missing for 18.5 percent of visits. The National Center for Health Statistics uses model-based single imputation for NHAMCS race and ethnicity data. The race imputation is restricted to three categories (white, black, and other) based on research by an internal work group and on quality concerns with imputed estimates for race categories other than white and black. The imputation technique is described in more detail in the 2011 NHAMCS Public Use Data File documentation, available at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHAMCS/doc11.pdf. 4

Other race includes visits by Asian, Native Hawaiian or other Pacific Islander, American Indian or Alaska Native, and persons with more than one race. NOTE: Numbers may not add to totals because of rounding. SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

Table 16. Injury visits to emergency departments, by body site: United States, 2011 Number of visits in thousands (standard Body site1 error in thousands) 2 40,220 (2,071) All injury visits Head and neck 4,705 (303) 371 (67) Traumatic brain injury 1,360 (126) Other head 1,410 (122) Face 477 (66) Eye 1,087 (112) Head, face, and neck unspecified Spinal cord * ... Vertebral column 1,630 (137) 819 (87) Cervical 174 (42) Thoracic and dorsal 588 (70) Lumbar * ... Other vertebral column Torso 1,771 (134) 641 (75) Chest * ... Abdomen 312 (52) Pelvis and urogenital 235 (40) Trunk 463 (66) Back and buttocks Upper extremity 7,390 (418) 1,325 (116) Shoulder and upper arm 1,095 (106) Forearm and elbow 4,543 (275) Wrist, hand, and fingers 426 (63) Other and unspecified upper extremity Lower extremity 6,071 (409) 561 (76) Hip * ... Upper leg and thigh 415 (61) Knee 1,630 (137) Lower leg and ankle 1,612 (145) Foot and toes 1,761 (157) Other and unspecified lower extremity System-wide 2,176 (189) Other and unspecified body site injuries 1,897 (200) Injury visit with multiple injury diagnoses 6,892 (419) 7,188 (449) Injury visit without injury diagnoses3 2,167 (174) Musculoskeletal conditions 814 (98) Skin conditions 1,256 (118) Symptoms, signs, ill-defined conditions 683 (73) Mental disorders 461 (67) Observation and evaluation 1,807 (151) All other diagnoses 489 (72) Unknown4

Percent distribution (standard error of percent) 100.0 ... 11.7 (0.5) 0.9 (0.2) 3.4 (0.3) 3.5 (0.3) 1.2 (0.2) 2.7 (0.2) * ... 4.1 (0.3) 2.0 (0.2) 0.4 (0.1) 1.5 (0.2) * ... 4.4 (0.3) 1.6 (0.2) * ... 0.8 (0.1) 0.6 (0.1) 1.2 (0.2) 18.4 (0.5) 3.3 (0.2) 2.7 (0.2) 11.3 (0.4) 1.1 (0.1) 15.1 (0.5) 1.4 (0.2) * ... 1.0 (0.1) 4.1 (0.2) 4.0 (0.3) 4.4 (0.3) 5.4 (0.4) 4.7 (0.4) 17.1 (0.6) 17.9 (0.5) 5.4 (0.3) 2.0 (0.2) 3.1 (0.3) 1.7 (0.2) 1.1 (0.1) 4.5 (0.3) 1.2 (0.2)

...Category not applicable. *Figure does not meet standards of reliability or precision. 1Based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM). (U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. Official version International Classification of Diseases, Ninth Revision, Clinical Modification, Sixth Edition. DHHS Pub No.(PHS) 06–1260)). A detailed description of the Barell Injury Diagnosis Matrix: Classification by Region of Body and Nature of the Injury can be found at http://www.cdc.gov/nchs/injury/ice/barell_matrix.htm. In this table, injury visits with a single injury diagnosis, whether first-, second-, or third-listed, are reported in the relevant body region category; 17.1% of injury visits had multiple injury diagnoses and are shown in a separate row of the table. Injury visits with multiple injury diagnoses can include visits in which there were multiple injuries within a single body site as well as visits in which there were injuries to more than one body site. 2The National Hospital Ambulatory Medical Care Survey definition of injury visits, as shown on this table, changed in 2010 and includes first-, second-, and third-listed reason for visit and diagnosis codes that are injury or poison related. Adverse effects and complications are excluded. Reason for visit was coded using A Reason for Visit Classification for Ambulatory Care; diagnosis and external cause of injury were coded using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM) (U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. Official version International Classification of Diseases, Ninth Revision, Clinical Modification, Sixth Edition. DHHS Pub No.(PHS) 06–1260). Injury visits, using this definition, accounted for 29.5 percent (SE=0.6) of all emergency department visits in 2011. For more details see the 2011 NHAMCS Public Use Data File documentation, available at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHAMCS/doc11.pdf. 3"Injury visit without injury diagnosis" include visits where injury status was based on first-, second-, or third-listed reason for visit or cause of injury codes. These are shown by their primary diagnosis group. 4Includes blank, uncodable, and illegible diagnoses. NOTE: Numbers may not add to totals because of rounding. SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

Table 17. Emergency department visits related to injury, poisoning, and adverse effect, by intent and mechanism: United States, 2011 Number of visits in thousands (standard Percent distribution Intent and mechanism1 error in thousands) (standard error of percent) 42,997 (2,181) 100.0 ... All visits related to injury, poisoning, and adverse effects1,2 Unintentional injuries 31,013 (1,680) 72.1 (0.9) Falls 11,324 (677) 26.3 (0.7) Motor vehicle traffic 3,828 (249) 8.9 (0.3) Struck against or struck accidentally by objects or persons 3,482 (230) 8.1 (0.4) Cutting or piercing instruments or objects 2,369 (174) 5.5 (0.3) Overexertion and strenuous movements 2,210 (170) 5.1 (0.3) Natural and environmental factors 2,091 (164) 4.9 (0.3) Poisoning 946 (111) 2.2 (0.2) Foreign body 780 (88) 1.8 (0.2) Caught accidentally in or between objects 405 (47) 0.9 (0.1) Pedal cycle, nontraffic and other 400 (64) 0.9 (0.1) Fire and flames, hot substances or object, caustic or corrosive and steam 393 (55) 0.9 (0.1) Motor vehicle, nontraffic 314 (69) 0.7 (0.2) Other transportation * ... * ... Suffocation * ... * ... Machinery 179 (35) 0.4 (0.1) 2,046 (218) 4.8 (0.4) Other mechanism3 Mechanism unspecified * ... * ... Intentional injuries 2,984 (206) 6.9 (0.3) Assault 2,061 (169) 4.8 (0.3) Unarmed fight or brawl, striking by blunt or thrown object 1,240 (123) 2.9 (0.2) Cutting or piercing instrument 127 (31) 0.3 (0.1) 693 (79) 1.6 (0.2) Other and unspecified mechanism4 Self-inflicted 836 (99) 1.9 (0.2) Poisoning by solid or liquid substances, gases, and vapors 509 (71) 1.2 (0.2) 327 (58) 0.8 (0.1) Other and unspecified mechanism5 Other causes of violence * ... * ... Injuries of undetermined intent 510 (74) 1.2 (0.2) Adverse effects of medical treatment 1,888 (147) 4.4 (0.3) Medical and surgical complications 1,157 (99) 2.7 (0.2) Adverse drug effects 731 (95) 1.7 (0.2) 134 (32) 0.3 (0.1) Alcohol and drug use6 6,468 (448) 15.0 (0.8) Unknown cause7 ...Category not applicable. *Figure does not meet standards of reliability or precision. 1

Based on "Supplementary Classification of External Cause of Injury or Poisoning" in the International Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM) (U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. Official version International Classification of Diseases, Ninth Revision, Clinical Modification, Sixth Edition. DHHS Pub No.(PHS) 06–1260). A detailed description of the ICD–9–CM E-codes used to create the groupings in this table can be found in the Technical notes Table I of Advance Data report no. 358, available at:http:/www.cdc.gov/nchs/data/ad/ad358.pdf. 2

The National Hospital Ambulatory Medical Care Survey definition of visits related to injury, poisoning and adverse effect, as shown on this table, changed in 2010 and includes first-, second-, and third-listed reason for visit and diagnosis codes related to injury, poisoning, or adverse effect. Such visits accounted for 31.5 percent (SE=0.6) of all emergency department visits in 2011. Reason for visit was coded using A Reason for Visit Classification for Ambulatory Care; diagnosis and external cause of injury were coded using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM). For more information on why this definition changed, see the 2011 NHAMCS Public Use Data File documentation, available at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHAMCS/doc11.pdf. 3

Includes drowning, firearms, and other mechanism.

4

Includes assaults by firearms and explosive, and other mechanism.

5

Includes injury by cutting and piercing instrument, suffocation, and other and unspecified mechanism.

6

Alcohol and drug abuse are not contained in the ''Supplementary Classification of External Causes of Injury and Poisoning,'' but are frequently recorded as a cause of injury or poisoning.

7

Includes illegible entries and blanks. NOTE: Numbers may not add to totals because of rounding. SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

Table 18. Selected diagnostic and screening services ordered or provided at emergency department visits: United States, 2011 Diagnostic and screening services ordered or provided All visits

Number of visits in thousands1 (standard error in thousands) 136,296 (6,413)

Percent of visits (standard error of percent) ... ...

One or more diagnostic or screening service listed None Blank

96,322 37,986 1,988

(4,710) (1,919) (209)

70.7 27.9 1.5

(0.6) (0.6) (0.1)

Blood tests Any blood test listed Complete blood count Blood urea nitrogen or creatinine Glucose Electrolytes Cardiac enzymes Liver function tests Prothrombin time or international normalized ratio (INR) Blood culture Arterial blood gases Blood alcohol concentration Other blood test

57,251 51,909 34,448 32,953 30,635 19,174 12,646 11,120 5,180 4,521 3,214 28,308

(2,946) (2,745) (2,419) (2,385) (2,420) (1,487) (1,233) (1,012) (427) (739) (305) (1,796)

42.0 38.1 25.3 24.2 22.5 14.1 9.3 8.2 3.8 3.3 2.4 20.8

(0.9) (0.9) (1.3) (1.2) (1.3) (0.9) (0.8) (0.6) (0.3) (0.5) (0.2) (1.0)

Imaging Any imaging X-ray Computed tomography scan Head Other than head Ultrasound Magnetic resonance imaging scan Other imaging

63,799 46,910 21,511 10,560 11,687 5,222 835 1,351

(3,216) (2,320) (1,285) (638) (777) (362) (87) (187)

46.8 34.4 15.8 7.7 8.6 3.8 0.6 1.0

(0.7) (0.6) (0.5) (0.3) (0.4) (0.2) (0.1) (0.1)

35,231 25,996 12,286 9,582 5,132 2,221 1,227 619 22,878

(1,890) (1,563) (1,008) (679) (476) (389) (253) (157) (2,189)

25.8 19.1 9.0 12.8 3.8 1.6 0.9 0.5 16.8

(0.6) (0.6) (0.6) (0.6) (0.3) (0.3) (0.2) (0.1) (1.3)

Examinations and tests Urinalysis Electrocardiogram Cardiac monitor Pregnancy test2 Toxicology screen Influenza test Wound culture HIV3 test Other test or service ...Category not applicable. 1

Total exceeds "all visits" because more than one service may be reported per visit.

2

Based on 74,621,000 female visits.

3

HIV is human immunodeficiency virus. SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

Table 19. Selected procedures at emergency department visits: United States, 2011

Procedure performed All visits One or more procedure listed


Percent of visits (Standard error of percent) ... ...

None1 Blank2

63,418 66,790 6,089

(3,303) (3,282) (724)

46.5 49.0 4.5

(0.9) (0.9) (0.5)

Intravenous fluids Splint or wrap Suturing or staples Nebulizer therapy Bladder catheter Pelvic exam Incision and drainage Foreign body removal Cast Endotracheal intubation Central line Cardiopulmonary resuscitation Other

39,562 7,668 4,448 3,984 2,854 2,548 1,620 489 335 259 151 122 10,426

(2,365) (473) (295) (326) (288) (275) (157) (62) (54) (40) (34) (29) (968)

29.0 5.6 3.3 2.9 2.1 1.9 1.2 0.4 0.2 0.2 0.1 0.1 7.6

(0.9) (0.3) (0.2) (0.2) (0.2) (0.2) (0.1) (0.0) (0.0) (0.0) (0.0) (0.0) (0.6)

...Category not applicable. 0.0 Quantity more than zero but less than 0.05. 1

The "none" checkbox was marked on the Patient Record form (PRF).

2

No checkboxes were marked on PRF. SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

Table 20. Medication therapy and number of medications mentioned at emergency department visits: United States, 2011

All visits


Visits with mention of medication2 Visits without mention of medication

109,384 26,913

(5,222) (1,465)

80.3 19.7

(0.6) (0.6)

Number of medications provided or prescribed3 All visits 0 1 2 3 4 5 6 7 8

136,296 26,913 33,970 29,468 19,666 11,799 6,366 3,676 2,265 2,173

(6,413) (1,465) (1,659) (1,438) (1,016) (692) (435) (315) (252) (231)

100.0 19.7 24.9 21.6 14.4 8.7 4.7 2.7 1.7 1.6

... (0.6) (0.5) (0.4) (0.3) (0.3) (0.2) (0.2) (0.2) (0.2)

Medication therapy1



Includes prescription drugs, over-the-counter preparations, immunizations, and anesthetics.

2

Visits at which one or more drugs were given in the emergency department (ED) or prescribed at discharge (up to eight per visit). Also defined as drug visit.

3

There were 286,227,000 drug mentions at emergency department visits in 2011. The average drug mention rate was 2.1 drug mentions per ED visit (standard error=0.03). For visits with at least one drug mention, the average drug mention rate was 2.6 drugs per visit (standard error=0.03). NOTE: Numbers may not add to totals because of rounding. SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

Table 21. Twenty most frequently mentioned drugs by therapeutic drug categories at emergency department visits: United States, 2011 Number of occurrences in thousands Percent of drug mentions2 Drug category1 (standard error in thousands) (standard error of percent) 97,578 (5,018) 34.1 (0.4) Analgesics3 Antiemetic or antivertigo agents 36,089 (2,106) 12.6 (0.3) Minerals and electrolytes 17,063 (1,676) 6.0 (0.4) Anxiolytics, sedatives, and hypnotics 13,682 (902) 4.8 (0.2) Miscellaneous respiratory agents 13,316 (1,504) 4.7 (0.4) Antihistamines 11,043 (774) 3.9 (0.2) Bronchodilators 9,720 (643) 3.4 (0.1) Cephalosporins 9,319 (517) 3.3 (0.1) Adrenal cortical steroids 8,990 (535) 3.1 (0.1) Penicillins 8,402 (472) 2.9 (0.1) Anticonvulsants 7,861 (524) 2.7 (0.1) Miscellaneous antibiotics 7,045 (399) 2.5 (0.1) Antiparkinson agents 5,354 (440) 1.9 (0.1) Quinolones 5,345 (358) 1.9 (0.1) Macrolide derivatives 5,294 (341) 1.8 (0.1) Antiarrhythmic agents 5,210 (396) 1.8 (0.1) Dermatological agents 5,165 (405) 1.8 (0.1) Local injectable anesthetics 5,107 (445) 1.8 (0.1) Muscle relaxants 4,899 (355) 1.7 (0.1) Antiplatelet agents 4,396 (365) 1.5 (0.1) 1

Based on Multum Lexicon second level therapeutic drug category (see http://www.multum.com/lexicon.html).

2

Based on an estimated 286,227,000 drug mentions at emergency department visits in 2011. Drug mentions are medications given in the emergency room or prescribed at discharge.

3

Includes narcotic and nonnarcotic analgesics and nonsteroidal anti-inflammatory drugs. SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

Table 22. Twenty most frequently mentioned drugs at emergency department visits: United States, 2011 Percent of mention (standard error of percent)

Drug name1 All drug mentions Ondansetron Ibuprofen Acetaminophenhydrocodone

Number of drug mentions in thousands (standard error in thousands) 286,227 (14,702) 18,977 (1,135) 18,338 (1,102) 16,876 (1,138)

Percent distribution (standard error of percent) 100.0 … 6.6 (0.2) 6.4 (0.2) 5.9 (0.2)

Total 100.0 100.0 100.0 100.0

Given in emergency department 57.6 (1.0) 77.8 (1.1) 34.0 (1.6) 21.5 (1.4)

Prescribed at discharge 31.5 (0.9) 8.0 (0.7) 49.1 (1.7) 62.9 (1.6)

Both given in emergency department and prescribed at discharge 9.5 (0.4) 12.9 (0.9) 15.4 (1.1) 14.9 (1.0)

Unknown2 1.4 (0.1) 1.3 (0.3) 1.5 (0.3) 0.7 (0.2)

Sodium chloride

13,192

(1,505)

4.6

(0.4)

100.0

96.6

(0.6)

0.9

(0.2)

*0.4

(0.1)

2.1

(0.4)

Acetaminophen Ketorolac Morphine Hydromorphone Acetaminophenoxycodone Albuterol Diphenhydramine

11,319 9,119 8,189 7,597 6,634

(652) (529) (570) (644) (601)

4.0 3.2 2.9 2.7 2.3

(0.2) (0.1) (0.1) (0.2) (0.2)

100.0 100.0 100.0 100.0 100.0

57.2 93.5 97.4 95.8 24.7

(2.3) (0.7) (0.5) (0.6) (2.4)

30.4 3.0 0.9 1.6 51.6

(1.8) (0.5) (0.2) (0.4) (2.6)

10.9 2.8 *0.3 1.8 22.6

(1.1) (0.5) (0.1) (0.4) (1.7)

1.5 *0.7 1.4 *0.8 *1.1

(0.3) (0.3) (0.4) (0.3) (0.4)

5,564 5,251

(422) (429)

1.9 1.8

(0.1) (0.1)

100.0 100.0

51.4 66.0

(2.2) (2.6)

28.6 20.0

(1.9) (2.0)

18.8 13.1

(1.4) (1.5)

1.2 *0.9

(0.3) (0.3)

Azithromycin Promethazine

4,739 4,257

(314) (361)

1.7 1.5

(0.1) (0.1)

100.0 100.0

29.0 50.4

(1.9) (2.4)

57.6 38.0

(2.5) (2.3)

11.9 9.9

(1.5) (1.8)

*1.5 *1.6

(0.5) (0.6)

Ceftriaxone Aspirin Amoxicillin Lorazepam

4,256 4,114 4,086 3,923

(321) (343) (308) (287)

1.5 1.4 1.4 1.4

(0.1) (0.1) (0.1) (0.1)

100.0 100.0 100.0 100.0

94.9 89.5 6.0 81.6

(0.9) (1.3) (1.1) (1.5)

*1.8 5.6 73.9 7.6

(0.6) (1.1) (2.6) (1.2)

1.1 1.9 19.1 8.4

(0.3) (0.5) (2.3) (1.0)

*2.2 3.1 *0.9 *2.4

(0.7) (0.8) (0.5) (0.7)

Lidocaine

3,849

(335)

1.3

(0.1)

100.0

92.7

(1.1)

4.2

(0.9)

*1.2

(0.5)

*2.0

(0.6)

Prednisone Sulfamethoxazoletrimethoprim All other

3,708 3,641

(260) (274)

1.3 1.3

(0.1) (0.1)

100.0 100.0

25.6 14.2

(2.2) (1.9)

48.6 66.8

(2.7) (3.0)

25.1 18.0

(2.1) (2.9)

*0.7 *1.0

(0.3) (0.4)

128,600

(6,530)

44.9

(0.5)

100.0

54.1

(1.3)

36.2

(1.3)

8.3

(0.5)

1.5

(0.2)


Based on Multum Lexicon terminology, the drug name reflects the active ingredients of a drug mention.

2

Unknown includes drugs given or prescribed that did not have either the "given in emergency department" or "prescribed at discharge" check boxes marked.

3

Based on Multum Lexicon second level therapeutic drug category (see http://www.multum.com/lexicon.html). SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

Therapeutic drug category3 Antiemetic or antivertigo agents Analgesics Analgesics Minerals and electrolytes, miscellaneous respiratory agents Analgesics Analgesics Analgesics Analgesics Analgesics Bronchodilators Antiemetic or antivertigo agents, antihistamines, antiparkinson agents, anxiolytics, sedatives, and hypnotics Macrolide derivatives Antiemetic or antivertigo agents, antihistamines Cephalosporins Analgesics, antiplatelet agents Penicillins Anticonvulsants, antiemetic or antivertigo agents, anxiolytics, sedatives, and hypnotics Antiarrhythmic agents, local injectable anesthetics Adrenal cortical steroids Miscellaneous antibiotics, sulfonamides …

Table 23. Providers seen at emergency department visits: United States, 2011 Type of provider All visits Any physician Emergency department attending physician Emergency department resident or intern Consulting physician Registered nurse (RN) or licensed practical nurse (LPN) Any physician seen Physician not seen Nurse practitioner Any physician seen Physician not seen Physician assistant Any physician seen Physician not seen Emergency medical technician Mental health provider Other Blank

Number of visits in thousands1 (standard error in thousands) 136,296 (6,413) 121,307 119,056 14,293 9,749 123,787 111,222 12,565 7,971 4,833 3,138 16,848 9,566 7,282 10,745 1,900 36,164 1,248

Percent of visits (standard error of percent) … ...

(5,797) (5,789) (1,728) (975) (6,115) (5,616) (1,381) (811) (550) (537) (1,815) (1,328) (1,146) (1,168) (217) (3,091) (161)


Combined total of providers seen exceeds "all visits" and percent of visits exceeds 100%, because more than one provider may be reported per visit. SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

89.0 87.4 10.5 7.2 90.8 81.6 9.2 5.8 3.5 2.3 12.4 7.0 5.3 7.9 1.4 26.5 0.9

(0.9) (1.2) (1.2) (0.6) (1.4) (1.6) (0.9) (0.5) (0.4) (0.4) (1.1) (0.9) (0.8) (0.8) (0.1) (1.9) (0.1)

Table 24. Disposition of emergency department visits: United States, 2011 Disposition All visits Admitted, transferred, or died Admit to this hospital Critical care unit Stepdown or telemetry unit Operation room Mental health or detoxification unit Cardiac catheterization lab Other bed or unit Unknown or blank Admit to observation unit Then hospitalized Then discharged Return or transfer to nursing home Transfer to psychiatric hospital Transfer to other hospital

Number of visits in thousands1 (standard error in thousands) 136,296 (6,413)

Percent of visits (standard error of percent) … ...

Died in emergency departmtent2

16,229 2,094 1,811 734 822 289 8,047 2,432 2,884 965 1,919 434 892 1,950 183

(1,127) (238) (337) (110) (105) (83) (618) (330) (458) (166) (340) (66) (122) (207) (31)

11.9 1.5 1.3 0.5 0.6 0.2 5.9 1.8 2.1 0.7 1.4 0.3 0.7 1.4 0.1

(0.6) (0.2) (0.2) (0.1) (0.1) (0.1) (0.4) (0.2) (0.3) (0.1) (0.2) (0.0) (0.1) (0.1) (0.0)

Outpatient follow-up Return to emergency department if needed (PRN) or by appointment Return or refer to physician or clinic for follow-up No follow-up planned

46,723 90,820 6,492

(3,335) (4,606) (850)

34.3 66.6 4.8

(2.3) (1.2) (0.6)

550 2,130 1,659 1,246 769

(79) (276) (177) (228) (111)

0.4 1.6 1.2 0.9 0.6

(0.1) (0.2) (0.1) (0.2) (0.1)

Left prior to completing visit Left before triage Left after triage Left against medical advice Other Blank ...Category not applicable. 0.0 Quantity more than zero, but less than 0.05. 1

Total exceeds "all visits" because more than one disposition may be reported per visit.

2

Includes "dead on arrival." SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

Table 25. Emergency department visits resulting in hospital admission, by selected patient and visit characteristics: United States, 2011

Selected characteristic All admissions



Mean length of stay in days1 (standard error in days) 5.0 (0.1)

Admissions as percent of visits (standard error of percent) 11.9 (0.6)

Age Under 15 years 15–24 years 25–44 years 45–64 years 65–74 years 75 years and over

767 886 2,703 4,814 2,452 4,605

(162) (98) (226) (396) (237) (388)

4.7 5.5 16.7 29.7 15.1 28.4

(1.0) (0.5) (0.9) (1.0) (1.0) (1.2)

3.6 4.0 4.6 4.8 5.4 5.8

(0.4) (0.3) (0.3) (0.2) (0.3) (0.2)

3.1 4.0 6.9 16.1 29.9 37.9

(0.6) (0.4) (0.5) (0.9) (1.7) (1.7)

13,982 1,222 301 109 616

(1,002) (120) (52) (22) (92)

86.2 7.5 1.9 0.7 3.8

(0.9) (0.6) (0.3) (0.1) (0.5)

4.9 6.3 6.5 5.0 6.0

(0.1) (0.3) (1.1) (0.9) (0.4)

11.1 47.8 21.5 9.9 12.4

(0.6) (3.0) (3.4) (1.9) (1.5)

6,542 7,518 4,014 1,202

(542) (633) (380) (123)

40.3 46.3 24.7 7.4

(1.5) (1.7) (1.5) (0.6)

4.7 5.7 5.2 4.5

(0.1) (0.1) (0.2) (0.3)

13.7 30.0 9.3 5.5

(0.9) (1.3) (0.7) (0.5)

6,794 9,434

(511) (667)

41.9 58.1

(1.0) (1.0)

5.7 4.5

(0.2) (0.1)

31.8 8.2

(1.4) (0.4)

5,240 10,988

(499) (764)

32.3 67.7

(1.7) (1.7)

5.2 5.0

(0.2) (0.1)

32.3 9.2

(1.8) (0.5)

771 15,458

(105) (1,071)

4.7 95.3

(0.5) (0.5)

5.4 5.0

(0.5) (0.1)

14.3 11.8

(1.5) (0.6)

1,025 15,204

(138) (1,051)

6.3 93.7

(0.7) (0.7)

5.8 5.0

(0.3) (0.1)

28.5 11.5

(2.6) (0.6)

4,029 5,013 2,751 1,253 639

(293) (419) (241) (135) (73)

24.8 30.9 17.0 7.7 3.9

(1.1) (1.1) (0.8) (0.6) (0.4)

... ... ... ... ...

... ... ... ... ...

... ... ... ... ...

... ... ... ... ...

Residence Private residence Nursing home Other Homeless Unknown or blank Expected sources of payment2 Private insurance Medicare Medicaid or CHIP3 No insurance4 Mode of arrival Ambulance Other Triage category Immediate or emergent Other Patient seen in this emergency department during the last 72 hours Yes No, unknown, or blank Patient discharged from any hospital within the last 7 days Yes No, unknown, or blank Length of stay 1–2 days 3–4 days 5–6 days 7–8 days 9–10 days

More than 10 days Unknown or blank Hospital discharge status Alive Home or residence Return or transfer to nursing home Transfer to another facility Other Unknown or blank Died Unknown or blank

1,191 1,354

(126) (243)

7.3 8.3

(0.6) (1.4)

... ...

... ...

... ...

... ...

14,486 11,022 1,552 1,112 211 *588 296 1,448

(1,038) (808) (176) (145) (38) (185) (54) (248)

89.3 76.1 10.7 7.7 1.5 *4.1 1.8 8.9

(1.5) (1.5) (0.9) (0.8) (0.3) (1.2) (0.3) (1.4)

5.0 4.5 6.9 7.6 5.3 5.8 6.4 4.7

(0.1) (0.1) (0.4) (0.6) (0.6) (0.4) (0.6) (0.4)

... ... ... ... ... ... ... ...

... ... ... ... ... ... ... ...

...Category not applicable. * Figure does not meet standards of reliability or precision. Denominator for length of stay is 14,875,000 visits where this variable was known. Length of stay was unknown in 8.3 percent of visits resulting in admission.

1

2

Total exceeds "all visits" because more than one source of payment may be reported per visit. Workers' compensation, other, and unknown sources of payment are not included in this table, but account for 5.1 percent of expected sources of payment.

3

CHIP is Children's Health Insurance Program.

4

No insurance is defined as having only self-pay, no charge, or charity as payment sources. The individual self-pay and no charge or charity categories are not mutually exclusive.

NOTE: Numbers may not add to totals because of rounding. SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

Table 26. Twenty leading principal hospital discharge diagnosis groups for emergency department visits: United States, 2011 Principal diagnosis group and ICD–9–CM code(s)1 All visits Heart disease, excluding ischemic Chest pain Pneumonia Psychoses, excluding major depressive disorder Cerebrovascular disease Ischemic heart disease Fracture of the lower limb Syncope and collapse Cellulitis and abscess Diabetes mellitus Chronic and unspecified bronchitis Urinary tract infection, site not specified Gastrointestinal hemorrhage Abdominal pain Anemias Fractures, excluding lower limb Disorder of gallbladder and biliary tract Asthma Malignant neoplasms Essential hypertension All other diagnoses2

... 391–392.0,393–398,402,404,415–416,420–429 786.5 480–486 290–295,296.0–296.1,296.4–299 430–438 410–414.9 820–829 780.2 681–682 249–250 490–491 599.0 578 789.0 280–285 800–819 574–576 493 140–208,209–209.36,209.7–209.79,230–234 401 ...

Number of visits in thousands (standard error in thousands) 16,229 (1,127) 969 937 701 459 452 403 389 312 310 301 285 282 273 268 237 236 228 185 184 184 8,634

(103) (123) (83) (70) (62) (64) (63) (51) (53) (53) (52) (55) (63) (51) (50) (45) (40) (43) (34) (41) (633)

Percent distribution (standard error of percent) 100.0 ... 6.0 5.8 4.3 2.8 2.8 2.5 2.4 1.9 1.9 1.9 1.8 1.7 1.7 1.7 1.5 1.5 1.4 1.1 1.1 1.1 53.2

(0.5) (0.6) (0.4) (0.4) (0.3) (0.3) (0.3) (0.3) (0.3) (0.3) (0.3) (0.3) (0.3) (0.3) (0.3) (0.3) (0.2) (0.2) (0.2) (0.2) (1.5)


Based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD–9–CM)(U.S. Department of Health Services. Centers for Medicare and Medicaid Service. Official version: International Classification of Diseases, Ninth Revision, Clinical Modification, Sixth Edition. DHHS Pub No.(PHS)06–1260). However, certain codes have been combined in this table to better describe the use of ambulatory care services. 2

All other diagnoses includes blanks and unknown diagnoses (10.3 percent). NOTE: Numbers may not add to totals because of rounding. SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

Table 27. Hospital and emergency department characteristics, by emergency department visit volume and metropolitan status: United States, 2011 ED annual visit volume Hospital and ED characteristics

All EDs Hospital characteristic Number of days in week that elective surgeries are scheduled: 0–4 5 6–7 Unknown or blank Has bed coordinator: Yes No Unknown or blank

Total

1

Metropolitan status

Fewer than 20,000

20,000 to 49,999

50,000 or more

Metropolitan area

Not metropolitan area

Percent distribution






(standard error) 100.0 ...






13.0 70.2 10.3 *6.5

(3.7) (4.4) (2.4) (2.0)

29.4 54.3 *10.5 *5.8

(7.8) (8.4) (4.7) (3.5)

*0.1 88.0 *6.7 *5.2

(0.1) (3.1) (2.1) (2.4)

*3.4 68.1 17.6 *10.9

(2.0) (5.9) (4.5) (4.0)

*8.2 71.0 14.6 *6.3

(3.8) (4.8) (3.5) (2.1)

*22.1 68.6 *2.1 *7.1

(7.4) (8.3) (2.0) (4.4)

66.2 26.8 *7.0

(4.5) (4.5) (2.6)

42.2 48.0 *9.8

(8.0) (8.6) (5.7)

80.9 13.7 *5.4

(4.3) (3.6) (2.3)

88.7 *7.2 *4.1

(3.9) (3.0) (2.7)

77.8 16.4 *5.8

(4.3) (3.8) (2.6)

44.0 46.7 *9.3

(8.2) (9.0) (5.9)

How often hospital bed census data are available: Instantaneously Every 4 hours Every 8–12 hours Every 24 hours Other Unknown or blank

79.8 *4.0 *2.2 6.4 *0.5 7.0

(3.3) (1.6) (1.3) (1.9) (0.3) (2.0)

86.6 *3.1 *5.9 *4.4

(5.6) (2.9) ... (3.1) ... (3.4)

73.4 *4.8 *4.8 *6.5 *1.2 *9.4

(4.6) (2.6) (3.1) (2.9) (0.8) (3.0)

78.3 *4.3 *1.8 *7.4 *0.4 *7.9

(4.4) (2.2) (0.9) (3.3) (0.4) (3.2)

71.7 *5.5 *3.4 7.9 *0.8 10.7

(4.2) (2.4) (1.9) (2.3) (0.5) (2.9)

95.3 *1.1 *3.6 -

(3.3) (1.2) ... (3.0) ... ...

ED characteristic ED uses electronic medical records Yes, all electronic Yes, part electronic No Unknown or blank

48.9 34.8 14.6 *1.7

(5.0) (3.8) (3.3) (1.4)

33.8 41.2 *21.7 *3.4

(8.4) (7.1) (7.0) (3.3)

59.9 29.1 11.0 -

(5.3) (5.1) (3.0) ...

59.4 32.5 *6.3 *1.8

(5.8) (5.2) (4.4) (1.0)

51.5 33.1 12.8 *2.7

(4.9) (4.3) (2.9) (2.1)

43.9 38.1 *18.0 -

(10.6) (6.9) (7.6) ...

Has observation or clinical decision unit Yes No Unknown or blank

20.7 75.2 *4.1

(3.5) (3.6) (1.8)

*18.3 77.8 *3.9

(6.4) (6.8) (3.3)

20.3 75.9 *3.8

(5.2) (5.6) (2.5)

27.0 68.0 *5.0

(4.8) (4.8) (2.5)

20.7 73.4 *5.9

(3.9) (4.0) (2.6)

*20.8 78.6 *0.6

(7.7) (7.7) (0.6)

62.4 32.5 *5.2

(4.1) (4.3) (1.9)

31.6 63.6 *4.8

(7.1) (7.4) (3.4)

83.3 *9.5 *7.2

(4.0) (2.9) (3.8)

86.7 *11.4 *1.9

(3.7) (3.5) (1.1)

76.1 18.2 *5.7

(4.5) (3.8) (2.7)

36.0 59.9 *4.1

(8.2) (8.5) (3.0)

20.0 73.1

(2.8) (4.0)

*17.0 72.5

(5.5) (8.2)

18.2 79.5

(4.2) (4.7)

30.8 60.9

(5.2) (6.3)

23.0 68.6

(3.2) (4.2)

*14.3 81.5

(5.2) (7.2)

Admitted patients were ever boarded 2 or more hours in the ED while waiting for an inpatient bed Yes No Unknown or blank If ED is critically overloaded, admitted patients are boarded in inpatient hallways or in another space outside the ED Yes No

Unknown or blank

*6.9

(2.6)

*10.5

(5.5)

*2.4

(2.3)

*8.3

(4.6)

*8.3

(3.1)

*4.1

(4.3)

33.4 55.9 10.7

(3.6) (3.7) (2.4)

18.8 72.4 *8.8

(5.3) (5.5) (4.3)

42.8 46.8 *10.4

(5.1) (5.3) (3.9)

46.1 38.4 15.5

(5.7) (5.4) (3.8)

41.6 48.0 10.4

(4.3) (4.1) (2.7)

*17.7 71.0 *11.2

(6.3) (7.1) (4.9)

52.9 38.3 *8.8

(6.2) (5.7) (4.2)

* * *

… … …

52.7 43.4 *3.9

(8.0) (7.8) (2.1)

64.6 29.5 *5.8

(8.2) (7.8) (2.4)

53.1 41.3 *5.6

(6.2) (6.0) (1.9)

* * *

… … …

64.4 16.9 18.6

(6.0) (4.5) (5.6)

* * *

… … …

70.3 *17.4 *12.3

(6.7) (5.5) (4.7)

61.9 *18.4 *19.7

(8.8) (6.8) (8.8)

70.7 15.5 *13.9

(5.2) (4.0) (4.3)

* * *

… … …

ED increased the number of standard treatment spaces in last 2 years Yes No Unknown or blank

22.3 73.6 *4.2

(3.2) (3.7) (1.8)

*15.4 81.3 *3.4

(5.4) (6.0) (3.3)

25.4 68.9 *5.7

(4.8) (5.3) (2.9)

31.0 66.2 *2.8

(5.8) (5.9) (1.5)

25.5 68.2 *6.4

(3.6) (4.3) (2.7)

*16.1 83.9 -

(6.7) (6.7) ...

ED physical space was expanded in last 2 years Yes No Unknown or blank

18.1 79.9 *2.0

(3.1) (3.4) (1.4)

*12.3 84.3 *3.4

(5.3) (5.8) (3.3)

18.5 81.0 *0.4

(4.5) (4.5) (0.4)

30.3 67.6 *2.1

(5.5) (5.5) (1.4)

20.0 77.0 *3.0

(3.2) (3.9) (2.1)

*14.5 85.5 -

(6.7) (6.7) ...

ED plans to expand physical space in next 2 years3 Yes No Unknown or blank

21.0 66.1 12.9

(3.9) (4.7) (3.0)

*19.1 64.6 *16.2

(7.1) (8.7) (5.9)

19.8 73.2 *7.0

(4.9) (5.8) (3.4)

29.0 53.0 18.0

(5.7) (7.3) (5.3)

25.8 59.6 14.6

(4.5) (5.0) (3.8)

*12.2 78.0 *9.8

(7.1) (8.8) (4.9)

80.1 59.0 45.3 6.2 65.9 15.4 54.8 52.7 39.8

(3.8) (3.4) (4.2) (1.8) (3.9) (2.8) (4.4) (4.0) (3.7)

67.9 46.3 *13.8 *5.1 45.4 5.2 31.2 54.8 37.9

(8.1) (6.0) (5.3) (3.3) (6.4) (0.8) (6.1) (6.5) (6.8)

87.2 63.3 62.6 *4.4 77.7 22.7 66.7 47.6 37.1

(3.9) (5.6) (5.3) (2.4) (5.4) (5.5) (5.2) (6.0) (6.0)

92.3 78.3 78.9 *12.1 86.9 22.7 82.2 58.6 49.6

(4.4) (5.2) (5.4) (3.9) (4.6) (4.6) (5.9) (5.6) (5.9)

82.6 61.5 54.6 6.2 69.6 16.0 60.1 47.4 41.0

(4.3) (4.1) (4.4) (1.5) (4.9) (3.4) (5.0) (4.5) (4.5)

75.2 54.3 27.3 *6.1 58.8 *14.3 44.6 62.8 37.4

(7.1) (5.2) (8.2) (4.3) (7.1) (4.5) (7.9) (8.5) (7.2)

ED went on ambulance diversion 2011 Yes No Unknown or blank Ambulance diversion is actively managed on a regional versus hospital level2 Yes No Unknown or blank Hospital continues to admit elective or scheduled surgery cases when ED is on ambulance diversion2 Yes No Unknown or blank

Services that ED uses: Bedside registration Computer-assisted triage Separate fast track unit for nonurgent care Separate operating room dedicated to ED patients Electronic dashboard4 Radio frequency identification tracking5 Zone nursing6 Pool nurses7 Full capacity protocol8

...Category not applicable. - Quantity equals zero. * Figure does not meet standards of reliability or precision. Only an asterisk (*) appears in the table if the estimates for the entire category are based on fewer than 30 cases in the sample data. Estimates based on 30 or more cases include an asterisk if the relative standard error of the estimate exceeds 30 percent. 1

Number of sample records: all emergency departments (N= 306); less than 20,000 (N= 60); 20,000 to 50,000 (N= 124); over 50,000 (N= 122); metropolitan area (N= 260); not metropolitan area (N= 46).

2

Denominator is number of EDs on ambulance diversion or for which ambulance diversion status is unknown.

3

Denominator is number of EDs that did not expand their physical space, including unknown or blank, in the last 2 years.

4

An electronic dashboard displays updated patient information and integrates multiple data sources.

5

Radio frequency identification tracking shows the exact location of patients, caregivers, and equipment.

6

Zone nursing refers to all of a nurse's patients being located in one area.

7

Pool nurses are those that can be pulled to the ED to respond to surges in demand.

8

A full capacity protocol allows some admitted patients to move from the ED to inpatient corridors while awaiting a bed. NOTE: ED is emergency department. SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

Table I. Reclassification of cause-of-injury codes for use with National Hospital Ambulatory Medical Care Survey data Intent and mechanism of injury Unintentional injuries Falls Motor vehicle traffic Struck against or struck accidentally by objects or persons Overexertion and strenuous movements Cutting or piercing instruments or objects Natural and environmental factors Poisoning by drugs, medicinal substances, biologicals, other solid and liquid substances, gases, and vapors Fire and flames, hot substance or object, caustic or corrosive material, and steam Machinery Pedal cycle, nontraffic and other Motor vehicle, nontraffic Other transportation Suffocation Firearm missile Drowning or submersion Foreign body Caught accidentally in or between objects Other and not elsewhere classified Mechanism unspecified Intentional injuries Assault Unarmed fight or brawl, striking by blunt or thrown object Cutting or piercing instrument Firearms Other and unspecified mechanism Self-inflicted Poisoning by solid or liquid substances, gases, and vapors Cutting and piercing instrument Suffocation Other and unspecified mechanism Other causes of violence Injuries of undetermined intent Adverse effects of medical treatment 1

Cause-of-injury code1 E800–E848, E850–E869, E880–E929 E880.0–E886.9, E888 E810–E819 E916–E917 E927 E920 E900–E909, E928.0–E928.2 E850–E869 E890–E899, E924 E919 E800–E807 (.3), E820–E825 (.6), E826.1, E826.9 E820–E825 (.0–.5, .7–.9) E800–E807 (.0–.2,.8–.9), E826 (.0, .2–.8), E827–E829, E831, E833–E845 E911–E913 E922.0–.3, .8–.9 E830, E832, E910 E914–E915 E918 E846–E848, E921, E922.4–5, E923, E925–E926, E928.3–.5, .8, E929.0–.5, .8 E887, E928.9, E929.9 E950–E979, E990–E999 E960–E969, E979 E960.0, E968.2 E966 E965.0–E965.4, E979.4 E960.1, E961–E964, E965.5–E965.9, E967–E968.1, E968.3–E969, E979.0–.3, .5–.9 E950–E959 E950–E952 E956 E953 E954–E955, E957–E959 E970–E978, E990–E999 E980–E989 E870–E879, E930–E949

Based on the "Supplementary Classification of External Causes of Injury and Poisoning," International Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM). (U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. Official version International Classification of Diseases, Ninth Revision, Clinical Modification, Sixth Edition. DHHS Pub No.(PHS) 06–1260).