National Patterns of Pediatric Emergency Department Utilization by Arrival Mode and Geographic Setting: Final Data from the National Hospital Ambulatory Medical Care Survey 2016–2022

OBJECTIVES To characterize national patterns of pediatric emergency department (ED) utilization from 2016 through 2022, with emphasis on emergency medical services (EMS) arrival, metropolitan status, and temporal changes in diagnostic composition.METHODS Cross-sectional analysis of the National Hospital Ambulatory Medical Care Survey (NHAMCS), a nationally representative survey of United States ED visits. Survey weights were applied to generate national estimates. Emergency departments of non-federal, general, and short-stay hospitals in the United States participating in NHAMCS. Pediatric visits (<18 years) from 2016 through 2022 were included. Main outcomes and measures included mode of arrival (EMS vs non-EMS), triage acuity, abnormal vital signs, ED disposition, metropolitan status, and discharge diagnoses categorized using pediatric-specific International Classification of Diseases, 10th Revision (ICD-10) groupings.RESULTS From 2016 through 2022, an estimated 202.5 million pediatric ED visits occurred, representing approximately 22% of all ED encounters. Of these, 9.0 million visits (4.4%) arrived by EMS after exclusion of interfacility transfers. Children comprised approximately 7% of EMS transports nationally. Compared with non-EMS arrivals, EMS-arriving children were more likely to be triaged as high acuity (29.8% vs 8.5%), to require hospital admission or transfer (24.9% vs 5.3%), and to have at least one abnormal vital sign (40.4% vs 22.6%). Injury and respiratory diseases were amongst the most common diagnostic categories for ED encounters overall. Psychiatric, behavioral, and substance use–related conditions accounted for approximately 12% of pediatric EMS encounters and increased over the study period. Although rural EDs cared for fewer pediatric visits overall, rates of abnormal vital signs were similar between urban and rural settings. Pediatric ED volume declined in 2020 and subsequently rebounded.CONCLUSIONS Children accounted for approximately one-fifth of ED visits but only about 1 in 14 EMS transports. Pediatric EMS encounters were disproportionately high acuity and included an increasing proportion of psychiatric and behavioral conditions. Rural EDs encountered similar physiologic severity despite lower pediatric volume. These patterns underscore the low-frequency but high-severity nature of pediatric EMS encounters and highlight considerations for pediatric readiness across both prehospital and hospital emergency care systems.