O2069: Non-Traumatic Dental-Related Emergency Department Visits and Admissions in Pediatric Patients in the Vizient Clinical Data Base, 2019-2023

Background: Oral health remains a significant public health issue. The use of emergency departments (EDs) and inpatient (IP) admissions for dental trauma is an expected use of healthcare, especially during hours when dental offices are closed. However, the use of the healthcare system for non-traumatic dental care (NTDC) can lead to strain on resources for disorders that can be more effectively treated through primary dental care.

Methods: A retrospective cohort of 173,959 ED encounters and 26,432 IP admissions for pediatric patients ( < 18 years) with a primary diagnosis of NTDC (ICD-10-CM K00-K14, M26-M27) at n=737 continuously reporting hospitals between 2019-2023 was extracted from the Vizient® Clinical Data Base. Patient vulnerability at the zip code level was analyzed using the Vizient Vulnerability Index, which assesses vulnerability from -3 (less vulnerable) to 3 (most vulnerable).

Results: Encounters with a NTDC increased by 1.4% between 2019 and 2023 and represented 0.6% of all pediatric ED encounters. Inpatient admissions for NTDC increased by 39.1% between 2019 and 2023 and represented 0.3% of all pediatric admissions. Compared to admitted patients for NTDC, patients who presented to the ED were more likely to be younger (7.0 vs 8.0 years), black (32.8% vs 18.8%), and have Medicaid (71.5% vs 60.2%). The most common NTDC primary diagnoses for ED patients were periapical abscess (24.3%) and dental caries (12.5%). The most common NTDC primary diagnoses for admitted patients were periapical abscess (11.5%) and cellulitis and abscess of the mouth (5.6%).
Patients with NTDC ED encounters were more vulnerable than admitted patients with NTDC (0.40 vs 0.19, p<.0001). The domain with the largest discrepancy between ED and admitted patients was the social environment domain, which includes voter participation rates, single-parent families, and incarceration rates, with ED patients having vulnerability index scores 0.29 higher than admitted patients (0.69 vs. 0.40, p<.0001). Compared to all pediatric patients with ED and inpatient encounters, those with NTDC primary diagnoses were more vulnerable (ED 0.40 vs 0.18, IP 0.19 vs. 0.00, both p<.0001). The domains with the largest discrepancies were social environment for ED patients (0.69 vs 0.48, p<.0001) and neighborhood resources domain, which includes park access, food deserts, opioid dispensing, alcohol sales and broadband availability and subscriptions, for IP (-0.26 vs -0.47, p<.0001).

Conclusion: While ED visits for NTDC in pediatric patients did not increase much from 2019 to 2023, IP admissions for NTDC increased by 39%. NTDC can place a burden on the healthcare system when more appropriate dental care settings are available. Additionally, there is an overrepresentation of more vulnerable patients utilizing the ED and admitted for NTDC, showing disparities in pediatric patients using healthcare for NTDC concerns. There are opportunities for dental care education to connect patients to resources to divert future inappropriate healthcare use.