national hospital ambulatory medical care survey: 2007 emergency department summary

8/9/2019 National Hospital Ambulatory Medical Care Survey: 2007 Emergency Department Summary

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Number26 n August6,2010

NationalHospitalAmbulatoryMedicalCareSurvey:2007EmergencyDepartmentSummary

byRichardNiska,M.D.,M.P.H.,F.A.C.E.P.;FaridaBhuiya,M.P.H.;andJianminXu,M.S.;DivisionofHealthCareStatistics

AbstractObjectiveThisreportpresentsdataonU.S.emergencydepartment(ED)

visitsin2007,withstatisticsonhospital,patient,andvisitcharacteristics.MethodsDataarefromthe2007NationalHospitalAmbulatoryMedical

CareSurvey,whichusesanationalprobabilitysampleofvisits toemergencydepartmentsofnonfederalgeneralandshort-stayhospitals in theUnitedStates.Sampledatawereweighted toproduceannualnationalestimates.

ResultsIn2007,therewereabout117millionEDvisitsintheUnitedStates.About25percentofvisitswerecoveredbyMedicaidortheStateChildrensHealthInsuranceProgram(SCHIP).Aboutone-fifthofEDvisitsbychildrenyoungerthan15yearsofagewere topediatricEDs.Therewere121EDvisitsforasthmaper10,000childrenunder5yearsofage.The leading injury-relatedcauseofEDvisitswasunintentionalfalls.Twopercentofvisitsresultedinadmissiontoanobservationunit.Electronicmedicalrecordswereused in62percentofEDs.Keywords:boardingelectronicmedicalrecordsemergencydepartmentvisitsovercrowding

IntroductionTheNationalHospitalAmbulatory

MedicalCareSurvey(NHAMCS)hasbeengathering,analyzing,anddisseminatinginformationabouthospitaloutpatientandemergencydepartments(EDs)since1992.NHAMCSand theNationalAmbulatoryMedicalCareSurvey(NAMCS)arepartsof theambulatorycomponentof theNationalHealthCareSurveys,afamilyofsurveysthatmeasurehealthcareutilizationacrossvarioustypesof

providers.More informationabout theNationalHealthCareSurveyscanbefoundat thefollowingwebsite:http://www.cdc.gov/nchs/nhcs.htm.

NHAMCSandNAMCSdatahavebeenusedinarticlesexaminingimportanttopicsofinterestinpublichealthandhealthservicesresearch.Foralist

of

publications,

see:

http://www.

cdc.gov/nchs/data/ahcd/publist-9-4

2009.pdf.InadditiontotheEDreport,otherreportshighlightvisits tooutpatientdepartments(OPDs)(1)and

physicianoffices(2).Annualreportsareavailablefrom:http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm.Public-usedatafilesareavailablefrom:http://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htm.DatafromNHAMCS2007willalsobeavailableonCDROM.Theseandotherproductscanbeobtainedfrom theNationalCenterforHealthStatistics(NCHS),OfficeofInformationServices,InformationDisseminationStaffat18002324636, theAmbulatoryandHospitalCareStatisticsBranchat3014584600,[email protected].

This2007reportbeginswithasummary

of

major

issues

in

emergency

medicineasarticulatedby theInstituteofMedicine(IOM), theAmericanCollegeofEmergencyPhysicians(ACEP),and theHealthyPeople2010(HP-2010)objectivesof theU.S.DepartmentofHealthandHumanServices.Thereport thenhighlightskeydataelementsonEDsfromNHAMCSthatarerelevanttothose issues.

In2006,IOMidentifiedseveralkeyissuesaffectingU.S.emergencymedicine,includingovercrowdingofEDs,lackofcriticalspecialists towhomEDscouldreferpatients,andgaps inemergencypediatriccare.Onovercrowding,theIOMnotedanincreaseinEDvisitsalongwitha

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics
http://www.cdc.gov/nchs/nhcs.htmhttp://www.cdc.gov/nchs/nhcs.htmhttp://www.cdc.gov/nchs/data/ahcd/publist-9-4-2009.pdfhttp://www.cdc.gov/nchs/data/ahcd/publist-9-4-2009.pdfhttp://www.cdc.gov/nchs/data/ahcd/publist-9-4-2009.pdfhttp://www.cdc.gov/nchs/data/ahcd/publist-9-4-2009.pdfhttp://www.cdc.gov/nchs/data/ahcd/publist-9-4-2009.pdfhttp://www.cdc.gov/nchs/data/ahcd/publist-9-4-2009.pdfhttp://www.cdc.gov/nchs/data/ahcd/publist-9-4-2009.pdfhttp://www.cdc.gov/nchs/data/ahcd/publist-9-4-2009.pdfhttp://www.cdc.gov/nchs/data/ahcd/publist-9-4-2009.pdfhttp://www.cdc.gov/nchs/data/ahcd/publist-9-4-2009.pdfhttp://www.cdc.gov/nchs/data/ahcd/publist-9-4-2009.pdfhttp://www.cdc.gov/nchs/data/ahcd/publist-9-4-2009.pdfhttp://www.cdc.gov/nchs/data/ahcd/publist-9-4-2009.pdfhttp://www.cdc.gov/nchs/data/ahcd/publist-9-4-2009.pdfhttp://www.cdc.gov/nchs/data/ahcd/publist-9-4-2009.pdfhttp://www.cdc.gov/nchs/data/ahcd/publist-9-4-2009.pdfhttp://www.cdc.gov/nchs/data/ahcd/publist-9-4-2009.pdfhttp://www.cdc.gov/nchs/data/ahcd/publist-9-4-2009.pdfhttp://www.cdc.gov/nchs/data/ahcd/publist-9-4-2009.pdfhttp://www.cdc.gov/nchs/data/ahcd/publist-9-4-2009.pdfhttp://www.cdc.gov/nchs/data/ahcd/publist-9-4-2009.pdfhttp://www.cdc.gov/nchs/data/ahcd/publist-9-4-2009.pdfhttp://www.cdc.gov/nchs/data/ahcd/publist-9-4-2009.pdfhttp://www.cdc.gov/nchs/data/ahcd/publist-9-4-2009.pdfhttp://www.cdc.gov/nchs/data/ahcd/publist-9-4-2009.pdfhttp://www.cdc.gov/nchs/data/ahcd/publist-9-4-2009.pdfhttp://www.cdc.gov/nchs/data/ahcd/publist-9-4-2009.pdfhttp://www.cdc.gov/nchs/data/ahcd/publist-9-4-2009.pdfhttp://www.cdc.gov/nchs/ahcd/ahcd_reports.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_reports.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_reports.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_reports.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_reports.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_reports.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_reports.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_reports.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_reports.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_reports.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_reports.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_reports.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_reports.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmmailto:[email protected]:[email protected]:[email protected]://www.cdc.gov/nchs/data/ahcd/publist-9-4-2009.pdfhttp://www.cdc.gov/nchs/nhcs.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_reports.htm


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Page2 NationalHealthStatisticsReports n Number26 n August6,2010decrease in thenumberofEDs.Thevisit increasewas tiednotonlytoprovisionofmedicalcare touninsuredpatients,butalsotoeveningandweekendcareof insuredpatientswhoseregularphysicianswereunavailable(3).TherehasbeenconcernaboutincreasingenrollmentinMedicaidasan indicatorofstresson thesafetynetsysteminwhichEDsplayamajorpart(4).DataonEDvisitrates,MedicaidanduninsuredstatusofthoseusingEDs,andtheuseofEDsforcare in theeveningandonweekendsarepresented inthisreport.

Accordingto theGovernmentAccountabilityOffice(GAO), themainissuecontributingtoovercrowdingofEDshasbeendelaysinmovingthesickestpatients toinpatientbeds(5).AdmittedpatientshaveoftenbeenboardedinEDsorhospitalhallwaysforhours todays,resulting inovercrowdinganddiversionofincomingambulancestootherhospitals(6).IOMrecommendedadoptingsystemstoevenouttheflowofpatientadmissionsandimplementing23-hourobservationunits(3).Thisreportpresentsdataonboardingandsystems toaddresspatientflow.

Onspecialistavailability,IOMfound

that

approximately

75

percent

of

hospitalshaddifficultyprovidingconsultantsto takecallsforemergencies.Onpediatriccare,IOMobserved thatmostchildrenreceivedcareingeneralEDs,rather thanpediatricfacilitieswithoptimalexpertiseandequipmenttohandletheiruniqueneeds(3).Included in thisreportaredataonvisitsinvolvingon-callphysiciansandpediatricEDs.

In its2009NationalReportCard,ACEPratedemergencydepartmentqualityofcare,includingpatientsafety,withrespect toascoringsystembasedon15qualityindicators.QualityofcarewasratedasaC+nationally,butindividualstatescoresvariedwidely.Hospitalcrowding,EDboarding,ambulancediversion,andhighratesofuninsuredindividualswerekey issuesimpactingqualityofcare(7).

DatafromNHAMCSareusedasanationalstandardforhealthcareestimates intheHP2010objectives.

NHAMCSEDvisitdatahavebeenusedtoestablishbaselineestimatesfortwoobjectivesrelatedtoreducingEDvisitsforasthmaandnonfataldogbiteinjuries.Theasthmaobjectivebreaksthepopulationinto threeagegroupsandidentifiesseparate targetsforreductionineachgroup(8).Thisreport includesdataonvisitratesforasthmaforeachoftheseagegroups,forinjuriesingeneral,andfordogbites inparticular.MethodsDatasource

ThisreportpresentsdataonEDvisits intermsofhospital,patient,andvisitcharacteristics.Thesedataarefromthe2007NHAMCS,anationalprobabilitysamplesurveyofnonfederal,general,andshort-stayhospitalsconductedbytheDivisionofHealthCareStatistics,NCHS,CentersforDiseaseControlandPrevention(CDC).ThesurveywasconductedfromJanuary1,2007,throughDecember30,2007.Themultistagedesign involvessamplinggeographicprimarysamplingunits(PSUs),hospitals thathaveEDsorOPDswithinPSUs,clinicswithinOPDs,

and

then

patient

visits

within

emergencyserviceareas(ESAs) inEDsandclinics inOPDs.WithinEDs,typesofESAsincludedgeneral,adult,pediatric,fast track,psychiatric,andtrauma.Thesampleof112PSUscomprisedaprobabilitysubsampleofPSUsused in the19851994NationalHealthInterviewSurveys(NHIS).In2007,asampleof482hospitalswasselectedfromasamplingframeconstructedfromhospitals listed inthe1991VerispanHospitalDatabaseupdatedusinghospitaldatafromVerispan,L.L.C.,specificallyitsHealthcareMarketIndex,UpdatedJuly15,2006andHospitalMarketProfilingSolution,SecondQuarter,2006.TheseproductswereformerlyknownastheSMGHospitalDatabase.Using the2006data toupdatethe2007sampleallowedfortheinclusionofhospitals thathadopenedorchangedtheireligibilitystatussince theprevioussamplewasupdatedfor2003.

HospitalstaffsorfieldrepresentativesfromtheBureauoftheCensuscompletedaPatientRecordForm(PRF)forasampleofvisitsduringa4-weekreportingperiod.Of thesampleof482hospitalsselectedforthe2007NHAMCS,384wereinscopeandhadeligibleEDs,and357of theseEDsresponded(ED-levelresponserateof93.0percentunweightedand92.6percentweightedfortheprobabilityofselection).Atotalof438of the477ESAswithintheparticipatingEDsrespondedandprovided35,490PRFs.Of these438ESAs,432respondedfullyoradequatelybyprovidingat leastone-halfoftheirexpectedforms(ESA-levelresponserateof90.6percentunweightedand93.1weighted).Theoverallresponserate,which istheproductof theresponseratesoftheEDsandtheESAs,was84.2percentunweightedand86.2percentweighted.Adetaileddiscussionofmethodologymaybefound in theTechnicalNotes.AsamplePRFis includedattheendofthisreport.Newdataitems

The2007surveyusesasimilardesignanddatacollectionformsas the2006

survey

(9),

but

some

items

have

beenexpandedoradded.Newitemsincluderespiratoryrateandepisodeofcare(initialorfollow-upvisit).Newdiagnosticandscreeningservicesincludeprothrombintime/internationalnormalizedratio(INR),bloodculture,toxicologyscreen,rapid influenzatest,andwoundculture.Thecomputerizedtomography(CT)scanandmagneticresonance imaging(MRI) itemsnowdifferentiatebetweenheadandotherscans.Forprocedures,orthopediccarehasbeenreplacedbycastandsplintorwrap,andwoundcarebylacerationrepair, incisionanddrainage,wounddebridement,andforeignbodyremoval.Residentshavebeenaddedtotheon-callattending/fellowcheckbox.Leftwithoutbeingseenhasbeenreplacedbydualcheckboxesforleftbeforeandaftermedicalscreeningexam.Deadonarrival(DOA)anddied inEDhavebeensplitintoseparateitems.Forhospitaladmission,step-downor telemetryunit


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115.3

30

25

20

119.2 116.8

113.9 110.2110.2108.0 107.5102.8

100.494.9

5

0

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

YearSOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey

Numberofvisits

15

10

NationalHealthStatisticsReports n Number26 n August6,2010 Page3andmentalhealthordetoxificationunithavebeenadded,andtheoperatingroomandcardiaccatheterization labhavebeensplitintoseparateitems.Alivehospitaldischargestatusnowhassubcategoriesforhomeand transferredtoanotherhospital.Testsofsignificance

Inthisreport, thedeterminationofstatisticalsignificance isbasedonthetwo-tailed t-test.TheBonferroniinequalitywasusedtoestablish thecriticalvalueforstatisticallysignificantdifferences(0.05 levelofsignificance)basedonthenumberofpossiblecomparisonswithinaparticularvariable(orcombinationofvariables)of interest.Aweighted leastsquaresregressionanalysiswasused todeterminethesignificanceof trendsat the0.05level.Termsrelating todifferencessuchasgreaterthanormore likelyorless thanorless likelyindicate thatthedifference isstatisticallysignificant.Alackofcommentregardingthedifferencedoesnotmeanthat thedifferencewastestedandfoundtobenotsignificant.ResultsEmergencydepartmentutilization+ In2007, therewere116.8millionEDvisitsor39.4visitsper100persons(Table1).Therewereabout222visitstoU.S.EDseveryminuteduring2007.

+TheannualnumberofvisitstoEDshas increasedby23percentsince1997(Figure1),while theannualvisitrateincreasedby11percent(datanotshown).

+About18.6percentofvisitsbychildrenyoungerthan15yearsofagewere topediatricEDs(datanotshown).

Patientcharacteristics+TheagegroupwithhighestannualEDvisitratewasinfantsunder12monthsold(88.5visitsper100U.S.infants).Thisrepresentsabout3.8millionvisits(Table2).

Figure1.Annualnumberofemergencydepartmentvisits(and95%confidence intervals):UnitedStates19972007

+ Personsaged75yearsandoverhadanannualEDvisitrateof62.0visitsper100U.S.persons(Table2).

+Thevisitrateforpersons living innursinghomeswasapproximatelyfour timeshigher thanforthoseliving inprivateresidences,for theoverallpopulationandforpersonsaged65orover(datanotshown).Nursinghomeresidentsaccountedforabout2.3millionvisits(Table2).

+Thevisitrateforhomelesspersonswasalmost twice thatofthose livinginprivateresidences(71.8comparedwith35.9visitsper100persons).Homelesspersonsaccountedfor542,000visits(Table2).

+ComparedwiththeEDvisitrateforwhitepersons(35.9visitsper100U.S.whitepersons), therateforblackpersonswasmorethandouble(74.6visitsper100U.S.blackpersons),andthatforAsianpersonswaslessthanone-half(16.0visitsper100U.S.Asianpersons)(Table3).

Timeofday+ For64.7percentofvisits,patientsarrived inEDsduringnonbusinesshours(5:00p.m. to8:00a.m.

Monday throughFriday,andontheweekends)(Table4).

+Duringtwo-thirdsofvisits,apatientspentfewer than4hoursintheED(Table4).

Modeofarrival+Patientsarrived inEDsbyambulanceforabout18million(15.5percent)visits(Table5).

+About44.9percentofpatients75yearsofageoroverarrivedatEDsbyambulance(Table5).

Paymentsource+Privateinsurancewasanexpectedsourceofpaymentfor39.0percentofallEDvisits(Table6).

+Othersourcesofpayment includedMedicaid

or

SCHIP

(25.2

percent)

andMedicare(17.2percent)(Table6).

+Uninsuredpatients,definedasself-payandnochargeorcharity,wherenootherpaymentsourcewasreported,represented15.3percentofvisits(Table6).

Triage+Patientsweretriagedasneeding tobeseenimmediatelyat4.5percentof


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Numberofvisitsper10,0

0

0persons

180

160

140

120

100

80

60

40

20

0

121.0

59.0

25.0

Under 5 5-64 years 65 and over

Patient's age in yearsSOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey

Page4 NationalHealthStatisticsReports n Number26 n August6,2010EDvisitsandwithin1to14minutes(emergent)at11.3percentofvisits.Patientswere triagedasneeding tobeseenwithin15 to60minutes(urgent)at38.5percent,1to2hours(semiurgent)at21.0percent,and2 to24hours(nonurgent)at7.9percentofvisits.At16.9percentofvisits,notriagewasdoneortriagetimewasunknownorblank(Table7).The termnonurgentdoesnot implyanunnecessaryvisit.

+Bloodpressurewasrecordedat95.8percentofvisitsbyadults18yearsofageorover(datanotshown).

+Temperaturewasin thefebrilerange(above38.0Cor100.4F)at4.8percent,normal(between35.1Cand38.0Cor95.1Fand100.4F)at87.9percent,and inthehypothermicrange(below35.0Cor95.0F)at0.4percentofvisits(Table8).

+Pulseoximetrywasrecordedat74.3percentofvisits(Table8).

+Patientspresentedwithseverepainat22.4percentofvisitsandwithmoderatepainduring23.3percentofvisits.Thepain levelwasnotrecordedat21.5percentofvisits(Table8).

Reasonsforvisits+Theleadingreasonsforvisitsamongchildren(underage15years)werefever,cough,andvomiting(Table9).

+Theleadingreasonsgivenbypatientsaged1564yearsforvisitingtheEDwerechestpainandabdominalpain(Table9).

+Theleadingreasonsgivenbyolderpatients(aged65yearsorover)forvisiting theEDwerechestpain,shortnessofbreath,andabdominalpain(Table9).

Primarydiagnoses+AcuteupperrespiratoryinfectionsandotitismediaorEustachian tubedisorderswere theleadingprimarydiagnoses inbothboysandgirlsunder15yearsofage(Table10).

+Forwomenbetween15and64yearsofage,abdominalpainandobstetrical

Figure2.Emergencydepartmentvisitratesforprimarydiagnosisofasthma(and95%confidence intervals)byagegroup:UnitedStates,2007

complicationswerethe leadingprimarydiagnoses,whileformen,openwoundsandcontusionswere theleadingdiagnoses(Table10).

+ Foradults65yearsofageandover,chestpainandnon-ischemicheartdiseasewere leadingprimarydiagnosesforbothmenandwomen(Table10).

+Therewere121.0EDvisitswithaprimarydiagnosisofasthmaper10,000childrenunder5yearsofage,59.0visitsper10,000personsbetween5and64yearsofage,and25.0visitsper10,000persons65yearsofageorover(Figure2).TheHP-2010targetis toreduceasthma-relatedEDvisitsto80from the1997baselineof150visitsper10,000forchildrenunder5yearsold(8).

Injury,poisoning,andadverseeffectsofmedicaltreatment+Visitsfor injury,poisoning,andadverseeffectsofmedicaltreatmentaccountedfor39.4millionvisits(33.7percent),or13.3visitsper100persons(Table11).

+Adults75yearsofageorover(19.1per100persons)had thehighestvisitratesfor injuries,poisoning,andadverseeffectsofmedical treatment,followedbyadults1524yearsofage(17.1per100persons)(Table11).

+Visitratesforinjury,poisoning,oradverseeffectsofmedical treatmentforblackpersons(22.1visitsper100U.S.blackpersons)werealmosttwicethoseforwhitepersons(12.6visitsper100U.S.whitepersons)(Table12).

+Ofall injury-relatedvisits,66.1percentwereforunintentionalinjuries,5.1percentwereforintentional injuries,4.3percentwereduetoadverseeffectsofmedicaltreatment,4.5percentwererelatedtoalcoholordrugabuse,and thecauseorintentof injurywasunknownorundeterminedfor20.0percent(Table13).

+Theleadingmentionedbodysitesforinjurieswerewrist,hand,andfingers(11.6percent)andface(4.7percent)(Table14).

+Therewereabout365,000EDvisitsfordogbites in2007.Therewereabout123EDvisitsfordogbitesper


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NationalHealthStatisticsReports n Number26 n August6,2010 Page5100,000persons in2007(datanotshown intables).

Diagnosticandscreeningservices+TheleadingtestsorderedorprovidedatEDvisitswerecompletebloodcounts(35.4percent),x-rays(33.8percent),andurinalyses(22.5percent)(Table15).

+CTscanswereorderedorprovidedat13.9percentofvisits,ofwhichaboutone-halfwereof thehead.MRIwasorderedorprovidedat0.7percentofvisits,ofwhichaboutone-halfwereof thehead(Table15).

+ ProthrombintimesorINRwereorderedorprovidedat5.2percent,toxicologyscreensat2.7percent,andrapid influenza testsat1.3percentofvisits(Table15).

+Bloodcultureswereorderedorprovidedat3.6percent,andwoundculturesat0.8percentofvisits(Table15).

Procedures+Procedureswereperformedat45.5percentofEDvisits.Theleadingprocedurementionedwasintravenousfluidadministration(26.6percentofvisits)(Table16).

+Splintsorwrapswereappliedat5.7percentandcastsat0.5percentofEDvisits(Table16).

+Lacerationswererepairedat4.4percentofvisits.Wounddebridementwasperformedat1.7percent, incisionanddrainageat1.0percent,andforeignbodyremovalat0.4percentofvisits(Table16).

Medicationsandimmunizations+Prescriptionorover-the-counterdrugs, immunizations,ordesensitizingmedicationswereeithergivenin theEDorprescribedatdischargeat76.3percentofvisits.Thisrepresentsabout213milliondrugmentions,or1.8drugmentionspervisit(2.4drugmentionspervisitwhenanymedicationwasgivenorprescribed)(Table17).

+TheleadingtherapeuticdrugclassesmentionedduringEDvisitswereanalgesics,includingnarcoticandnonnarcoticpainmedicationsandnonsteroidalanti-inflammatorydrugs(36.3percentofdrugmentions),andantibiotics(15.7percent)(Table18).Antibioticsincludecephalosporins,penicillins,quinolones,macrolides,sulfonamides,andmiscellaneousantibioticsfromTable18.

+Toxoidscomprised1.3percentofdrugmentionsatEDvisits(Table18).Therewereabout1.4milliondosesof tetanus toxoidandabout1.3milliondosesoftetanus-diphtheria toxoidcombinationsadministeredatEDvisitsin2007(datanotshown).

+The leadingdrugsgiven in theEDwereacetaminophen(aloneorwithhydrocodoneoroxycodone)(5.9percentofdrugmentions),ketorolac(3.3percent),morphine(3.1percent),andibuprofen(3.0percent)(Table19).

+The leadingdrugsprescribedatdischargewereacetaminophen(aloneor incombinationwithhydrocodoneoroxycodone)(8.9percentofdrugmentions)andibuprofen(4.6percent)(Table19).

+Cephalosporins(1.9percent),includingceftriaxoneandcephalexin,weretheleadingantibioticsgivenintheED.Amoxicillin(1.5percent)wastheleadingantibioticprescribedatdischarge(Table19).

Healthcareproviders+ Patientssawphysiciansat89.7percent,physicianassistantsat9.2percent,andnursepractitionersat4.0percentofEDvisits(Table20).

+ PatientssawanEDattendingphysicianat86.9percent;anEDresidentor internat8.0percent;andanon-callattendingphysician,fellow,orresidentat4.7percentofvisits(Table20).

Disposition+ Patientswerereferred toanoutsidephysicianorclinicat61.7percent,advised toreturn totheEDasneeded

orbyappointmentat35.4percent,andreferred tosocialservicesat0.8percentofvisits.Nofollow-upwasplannedat5.4percentofvisits(Table21).

+Thepatientdied intheEDat0.1percentofvisits.Thenumberofvisitsatwhich thepatientwasDOAwas toosmalltorepresentareliablenationalestimate(Table21).

Hospitaladmissions+Patientswereadmitted to thesamehospitalat12.5percentofvisits(14.6million);admittedtoanobservationunitat2.1percentofvisits(2.5million);and transferred toadifferenthospitalat1.8percentofvisits(2.1million)(Table21).

+Amongvisitsresulting inadmission,11.5percentofpatientswent toacriticalcareunitand19.8percentwenttoastep-downor telemetryunit(calculatedfromTable21).

+Amongvisitsresulting inadmission,4.4percentofpatientswent totheoperatingroom(calculatedfromTable21).Therewere toofewvisitsresulting inadmissiontoacardiaccatheterizationlaboratory tomakeareliablenationalestimate.

+Among

visits

resulting

in

admission,

about4.0percentofpatientswenttoamentalhealthordetoxificationunit(calculatedfromTable21).

+Themeanlengthofthehospitalstayforpatientsadmittedfrom theEDwas5.3days.NursinghomeresidentsadmittedfromtheEDstayedinthehospitalforameanof7.4days(Table22).

+Themeanhospital lengthofstaywas6.0daysforpatientswithMedicare,5.4daysforpatientswithMedicaidorSCHIP,5.2daysforpatientswithnoinsurance,and4.9daysforpatientswithprivate insurance(Table22).

+Amongpatientsdischargedalivefromthehospital,76.9percentwenthome,7.4percentwere transferred,and5.1percentweredischarged toanotherlocation.Thedischargedispositionwasunknownorblankfor10.6percentofpatientsdischargedalive(Table22).


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Page6 NationalHealthStatisticsReports n Number26 n August6,2010+Amongthoseadmittedfrom theED,the leadingprincipalhospitaldischargediagnoseswerenon-ischemicheartdisease(6.3percentofadmissions),chestpain(5.7percent),pneumonia(3.5percent),andcerebrovasculardisease(3.0percent)(Table23).

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9. PittsSR,NiskaRW,XuJ,BurtCW.NationalHospitalAmbulatoryMedicalCareSurvey:2006

emergencydepartmentsummary.Nationalhealthstatisticsreports;no7.Hyattsville,MD:NationalCenterforHealthStatistics.2008.

10.BurtCW,HingE.Useofcomputerizedclinicalsupportsystemsinmedicalsettings:UnitedStates,

20012003.

Advance

data

fromvitalandhealthstatistics;no353.Hyattsville,MD:NationalCenterforHealthStatistics.2005.

11.DesRochesCM,CampbellEG,RaoSR,DonelanK,FerrisTG,etal.Electronichealthrecordsinambulatorycareanationalsurveyofphysicians.NEJM;359:5060.2008.

12.HealthinformationtechnologyintheUnitedStates:Wherewestand,2008.RobertWoodJohnsonFoundation.2008.

13.SchneiderD,AppletonL,McLemoreT.Areasonforvisitclassificationforambulatorycare.NationalCenterforHealthStatistics.VitalHealthStat2(78).1979.

14.U.S.DepartmentofHealthandHumanServices.CentersforDiseaseControlandPrevention,CentersforMedicareandMedicaidServices.OfficialversionInternationalClassificationofDiseases,NinthRevision,ClinicalModification,SixthEdition.DHHSPubNo.(PHS)061260.

15.McCaigLF,BurtCW.NationalHospitalAmbulatoryMedicalCareSurvey:2003emergencydepartmentsummary.Advancedatafromvitalandhealthstatistics;no358.Hyattsville,MD:NationalCenterforHealthStatistics.2005.

16.TheBarellinjurydiagnosismatrix,classificationbybodyregionandnatureoftheinjury.Availablefrom:http://www.cdc.gov/nchs/data/ice/final_matrix_post_ice.pdf.AccessedJanuary14,2010.

17.KochH,CampbellW.Thecollectionandprocessingofdrug information:NationalAmbulatoryMedicalCareSurvey,UnitedStates,1980.NationalCenterforHealthStatistics.VitalHealthStat2(90).1982.

18.NationalCenterforHealthStatistics.Public-usedatafiledocumentation,2007.NationalHospitalAmbulatoryMedicalCareSurvey.Hyattsville,MD.2009.Availablefrom:http://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htm.AccessedJanuary8,2010.

19.SUDAAN(release9.0.1)[ComputerSoftware].ResearchTrianglePark,NC:ResearchTriangleInstitute.2005.

20.NationalCenterforHealthStatistics.NationalNursingHomeSurvey:2004overview.Hyattsville,MD.2009.Availablefrom:http://www.cdc.gov/nchs/nnhs.htm.AccessedDecember18,2009.

21.OfficeofCommunityPlanningandDevelopment,U.S.DepartmentofHousingandUrbanDevelopment.ThethirdannualhomelessassessmentreporttoCongress.Washington,DC.2008.Availablefrom:http://www.hudhre.info/documents/3rdHomelessAssessmentReport.pdf.AccessedOctober15,2009.
http://www.cdc.gov/nchs/data/ice/final_matrix_post_ice.pdfhttp://www.cdc.gov/nchs/data/ice/final_matrix_post_ice.pdfhttp://www.cdc.gov/nchs/data/ice/final_matrix_post_ice.pdfhttp://www.cdc.gov/nchs/data/ice/final_matrix_post_ice.pdfhttp://www.cdc.gov/nchs/data/ice/final_matrix_post_ice.pdfhttp://www.cdc.gov/nchs/data/ice/final_matrix_post_ice.pdfhttp://www.cdc.gov/nchs/data/ice/final_matrix_post_ice.pdfhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htmhttp://www.cdc.gov/nchs/nnhs.htmhttp://www.cdc.gov/nchs/nnhs.htmhttp://www.cdc.gov/nchs/nnhs.htmhttp://www.cdc.gov/nchs/nnhs.htmhttp://www.cdc.gov/nchs/nnhs.htmhttp://www.cdc.gov/nchs/nnhs.htmhttp://www.cdc.gov/nchs/nnhs.htmhttp://www.cdc.gov/nchs/nnhs.htmhttp://www.cdc.gov/nchs/nnhs.htmhttp://www.cdc.gov/nchs/nnhs.htmhttp://www.cdc.gov/nchs/nnhs.htmhttp://www.hudhre.info/documents/3rdHomelessAssessmentReport.pdfhttp://www.hudhre.info/documents/3rdHomelessAssessmentReport.pdfhttp://www.hudhre.info/documents/3rdHomelessAssessmentReport.pdfhttp://www.hudhre.info/documents/3rdHomelessAssessmentReport.pdfhttp://www.hudhre.info/documents/3rdHomelessAssessmentReport.pdfhttp://www.hudhre.info/documents/3rdHomelessAssessmentReport.pdfhttp://www.hudhre.info/documents/3rdHomelessAssessmentReport.pdfhttp://www.hudhre.info/documents/3rdHomelessAssessmentReport.pdfhttp://www.hudhre.info/documents/3rdHomelessAssessmentReport.pdfhttp://www.hudhre.info/documents/3rdHomelessAssessmentReport.pdfhttp://www.hudhre.info/documents/3rdHomelessAssessmentReport.pdfhttp://www.cdc.gov/nchs/nnhs.htmhttp://www.hudhre.info/documents/3rdHomelessAssessmentReport.pdfhttp://www.cdc.gov/nchs/data/ice/final_matrix_post_ice.pdfhttp://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htm


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NationalHealthStatisticsReports n Number26 n August6,2010 Page7Table1.Number,percentdistribution,andannualrateofemergencydepartmentvisitswithcorrespondingstandarderrors,byselectedhospitalcharacteristics:UnitedStates,2007

NumberofNumberof (Standard (Standard visitsper (Standard

visits in error in Percent errorof 100persons errorSelectedhospitalcharacteristics thousands thousands) distribution percent) peryear13 ofrate)

All vi si t s. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116,802 (6,293) 100.0 ... 39.4 (2.1)Ownership

Voluntary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87,511 (5,727) 74.9 (2.8) 29.5 (1.9)Government . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13,828 (1,997) 11.8 (1.8) 4.7 (0.7)Proprietary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,463 (3,190) 13.2 (2.5) 5.2 (1.1)

GeographicregionNo rth east . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20,484 (1,834) 17.5 (1.6) 38.0 (3.4)Midwe st . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25,062 (2,652) 21.5 (2.1) 38.4 (4.1)South . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48,713 (4,418) 41.7 (2.8) 45.0 (4.1)We st . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22,543 (3,224) 19.3 (2.4) 32.7 (4.7)

Metropolitanstatus2Metropolitan statistical a re a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99,074 (6,371) 84.8 (1.9) 39.8 (2.6)Nonmetropolitan statistical area . . . . . . . . . . . . . . . . . . . . . . . . . . 17,728 (2,128) 15.2 (1.9) 37.5 (4.5)

MedicalschoolaffiliationYes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62,265 (4,943) 53.3 (3.0) 21.0 (1.7)No or blank . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54,537 (4,414) 46.7 (3.0) 18.4 (1.5)

TraumacenterYes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41,276 (4,566) 35.3 (3.4) 13.9 (1.5)No or blank . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75,526 (5,577) 64.7 (3.4) 25.5 (1.9)

Season4Wi n t e r. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34,667 (4,031) 29.7 (2.6) 11.7 (1.4)S p ri n g . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30,939 (3,576) 26.5 (2.6) 10.4 (1.2)Summer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28,674 (3,885) 24.5 (3.2) 9.7 (1.3)Fall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22,522 (2,554) 19.3 (2.2) 7.6 (0.9). . . Categorynotapplicable.1Visitrates forregionarebasedon theJuly1,2007,setof theestimatesof theciviliannoninstitutionalpopulationof theUnitedStatesasdevelopedby thePopulationDivision,U.S.CensusBureau.SeeMethodsformoredetails.2Populationestimatesofmetropolitanstatisticalarea(MSA)statusarebasedondata fromthe2007NationalHealth InterviewSurvey,NationalCenter forHealthStatistics,adjusted to theU.S.CensusBureaudefinitionofcore-basedstatisticalareasasofDecember2007.Seehttp://www.census.gov/population/www/metroareas/metrodef.htmlformoreaboutMSAdefinitions. 3ForgeographicregionandMSA,populationdenominatorsaredifferent foreachcategory,and thusdonotadd tototalpopulationrate.Forothervariables,thedenominator isthetotalpopulationforeachstratum.4Winter isDecember22 toMarch19;spring isMarch20toJune20;summer isJune21toSeptember22;andfall isSeptember23 toDecember21.NOTE:Numbersmaynotadd tototalsbecauseofrounding.
http://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.html


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Page8 NationalHealthStatisticsReports n Number26 n August6,2010Table2.Number,percentdistribution,andannualrateofemergencydepartmentvisitswithcorrespondingstandarderrors,bypatientage,sex,andresidence:UnitedStates,2007


visits in error in Percent errorof 100persons errorSelectedpatientcharacteristics thousands thousands) distribution percent) peryear1 ofrate)

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116,802 (6,293) 100.0 ... 39.4 (2.1)Age

Under15years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22,308 (1,864) 19.1 (1.1) 36.7 (3.1)Under1year. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,766 (426) 3.2 (0.3) 88.5 (10.0)14years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,340 (729) 7.1 (0.5) 50.7 (4.4)514years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,202 (790) 8.7 (0.4) 25.4 (2.0)

1524years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18,983 (1,257) 16.3 (0.4) 45.7 (3.0)2544years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33,485 (1,843) 28.7 (0.5) 41.0 (2.3)4564years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24,491 (1,342) 21.0 (0.5) 32.2 (1.8)65yearsandover . . . . . . . . . . . . . . . . . . . . . . . . . . . 17,535 (1,014) 15.0 (0.5) 48.4 (2.8)

6574years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,908 (412) 5.9 (0.2) 36.2 (2.2)75yearsandover. . . . . . . . . . . . . . . . . . . . . . . . . . 10,627 (645) 9.1 (0.3) 62.0 (3.8)

SexandageFemale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63,170 (3,426) 54.1 (0.5) 41.8 (2.3)

Under15years . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,072 (859) 8.6 (0.5) 33.9 (2.9)1524years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,084 (712) 9.5 (0.2) 54.0 (3.5)2544years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18,698 (1,037) 16.0 (0.4) 45.4 (2.5)4564years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12,776 (728) 10.9 (0.3) 32.7 (1.9)6574years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,723 (255) 3.2 (0.1) 36.0 (2.5)75yearsandover. . . . . . . . . . . . . . . . . . . . . . . . . . 6,816 (427) 5.8 (0.2) 65.7 (4.1)

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53,632 (2,968) 45.9 (0.5) 37.0 (2.0)Under15years . . . . . . . . . . . . . . . . . . . . . . . . . . . 12,236 (1,047) 10.5 (0.7) 39.3 (3.4)1524years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,899 (594) 6.8 (0.3) 37.7 (2.8)2544years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14,786 (873) 12.7 (0.3) 36.5 (2.2)4564years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,715 (661) 10.0 (0.3) 31.7 (1.8)6574years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,185 (197) 2.7 (0.1) 36.3 (2.2)75yearsandover. . . . . . . . . . . . . . . . . . . . . . . . . . 3,811 (261) 3.3 (0.2) 56.4 (3.9)

PatientresidencePrivateresidence. . . . . . . . . . . . . . . . . . . . . . . . . . . . 106,436 (5,937) 91.1 (0.5) 35.9 (2.0)Nursing home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,323 (175) 2.0 (0.1) 155.7 (11.7)Other institut ion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,077 (126) 0.9 (0.1) 42.3 (5.0)Otherresidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . 604 (85) 0.5 (0.1) 0.2 (0.0) Homeless . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 542 (72) 0.5 (0.1) 71.8 (9.6) Unknownorblank . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,820 (613) 5.0 (0.5) ... .... . . Categorynotapplicable.1Visitrates forage,sex,privateresidence,andotherresidencearebasedon theJuly1,2007,setofestimatesof theciviliannoninstitutionalizedpopulationof theUnitedStatesasdevelopedbythePopulationDivision,U.S.CensusBureau.Visitrates fornursinghomeresidentsarebasedonthe2004CDC/NCHSNationalNursingHomeSurvey(20).Visitrate forhomelesspeople isbasedon theAnnualHomelessAssessmentReport toCongressby theU.S.DepartmentofHousingandUrbanDevelopment(21).NOTE:Numbersmaynotadd tototalsbecauseofrounding.


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http://www.cdc.gov/nchs/ahcd.htm


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Page10 NationalHealthStatisticsReports n Number26 n August6,2010Table4.Numberandpercentdistributionofemergencydepartmentvisitswithcorrespondingstandarderrors,bytimespentwaitingtoseeaphysicianandtimespentintheemergencydepartment:UnitedStates,2007

Numberof (Standard (Standardvisits in error in Percent errorof

Visitcharacteristic thousands thousands) distribution percent)All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116,802 (6,293) 100.0 ...

Timespentwaitingtoseeaphysician1Fewer than 15 minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20,803 (1,537) 17.8 (1.0)1559minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41,657 (2,216) 35.7 (1.3)1hour,but fewer than2hours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16,683 (1,080) 14.3 (0.6)2hours,butfewerthan3hours. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,846 (487) 5.0 (0.3)3hours,butfewerthan4hours. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,272 (247) 1.9 (0.2)4hours,butfewerthan6hours. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,584 (187) 1.4 (0.2)6hoursormore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 906 (132) 0.8 (0.1)Notseenbyaphysician . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,236 (1,136) 8.8 (0.7)Blank . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16,815 (2,433) 14.4 (1.7)

Timespent intheemergencydepartmentLessthan1hour. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13,256 (934) 11.3 (0.6)1hour,butfewerthan2hours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26,959 (1,551) 23.1 (0.5)2hours,butfewerthan4hours. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38,732 (2,274) 33.2 (0.6)4hours,butfewerthan6hours. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16,456 (994) 14.1 (0.4)6hours,butfewerthan10hours. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,410 (609) 8.1 (0.4)10hours,but fewer than14hours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,999 (169) 1.7 (0.1)14hours,but fewer than24hours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,538 (177) 1.3 (0.1)24hoursormo re . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 606 (123) 0.5 (0.1)Blank . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,845 (1,382) 6.7 (1.1)

Patientarrived inemergencydepartmentafterbusinesshours2Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75,565 (4,160) 64.7 (0.4)No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39,796 (2,111) 34.1 (0.3) Blank . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,441 (384) 1.2 (0.3). . . Categorynotapplicable.1Themedianwaitingtimetoseeaphysicianwas33.0minutes.2BusinesshoursdefinedasMonday throughFriday8a.m. to5p.m.NOTE:Numbersmaynotaddto totalsbecauseofrounding.

Table5.Percentdistributionofemergencydepartmentvisitswithcorrespondingstandarderrors,bypatientmodeofarrivalaccordingtopatientage:UnitedStates,2007

Numberof Patientsmodeofarrivalvisits in

Patientage thousands Total Walk-in1 Ambulance Publicservice2 Unknown3Percentdistribution(standarderrorofpercent)

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116,802 100.0 75.2 (1.0) 15.5 (0.6) 2.3 (0.6) 7.0 (0.8)Age

Under15years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22,308 100.0 87.6 (1.0) 4.2 (0.5) *1.4 (0.4) 6.8 (0.8)Under1year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,766 100.0 87.2 (1.4) 4.1 (0.9) * ... 7.1 (1.0)14years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,340 100.0 88.1 (1.4) 3.6 (0.6) *1.0 (0.4) 7.3 (1.1)514years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,202 100.0 87.4 (1.0) 4.6 (0.5) 1.7 (0.5) 6.3 (0.9)1524years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18,983 100.0 80.3 (1.3) 10.3 (0.7) *2.5 (0.9) 6.9 (0.9)2544years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33,485 100.0 78.3 (1.1) 11.7 (0.6) 2.8 (0.7) 7.1 (0.9)4564years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24,491 100.0 70.9 (1.1) 19.1 (0.7) 2.6 (0.6) 7.3 (0.9)65yearsandover . . . . . . . . . . . . . . . . . . . . . . . . . . . 17,535 100.0 53.7 (1.5) 37.6 (1.4) 1.8 (0.4) 6.9 (0.9)6574years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,908 100.0 63.9 (1.5) 26.5 (1.3) 1.6 (0.4) 8.0 (1.2)75yearsandover . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,627 100.0 47.1 (1.8) 44.9 (1.8) 1.9 (0.5) 6.2 (0.9). . . Categorynotapplicable.*Figuredoesnotmeetstandardsofreliabilityorprecision.1Includespatientsarrivingbycar, taxi,bus,oron foot.2Includespatientsarriving inpublicservicevehiclessuchaspolicecars,socialservicevehicles,beachpatrol,orescortedorcarriedbyapublicserviceofficial.3Theunknowncategoryincludesblanks.NOTE:Numbersmaynotaddto totalsbecauseofrounding.


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NationalHealthStatisticsReports n Number26 n August6,2010 Page11Table6.Numberandpercentageofemergencydepartmentvisitswithcorrespondingstandarderrors,byexpectedsourcesofpayment:UnitedStates,2007

Numberof (Standard (Standardvisits in error in Percent error

Expectedsourcesofpayment thousands1 thousands) ofvisits ofpercent)All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116,802 (6,293) ... ...Private insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . 45,580 (2,864) 39.0 (1.3)MedicaidorSCHIP2. . . . . . . . . . . . . . . . . . . . . . . . . . 29,379 (1,780) 25.2 (1.0)Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20,133 (1,180) 17.2 (0.6)

MedicareandMedicaid3. . . . . . . . . . . . . . . . . . . . . . 3,478 (276) 3.0 (0.2)No insurance4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17,926 (1,317) 15.3 (0.8)

Self-pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17,037 (1,285) 14.6 (0.8)Nochargeorcharity . . . . . . . . . . . . . . . . . . . . . . . . 1,155 (271) 1.0 (0.2)

Workerscompensation. . . . . . . . . . . . . . . . . . . . . . . . 1,823 (182) 1.6 (0.1)Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,764 (311) 2.4 (0.3) Unknownorblank . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,484 (2,109) 9.0 (1.7). . . Categorynotapplicable.1Totalexceedsallvisitsbecausemore thanonesourceofpaymentmaybereportedpervisit.2SCHIPis theStateChildrensHealth InsuranceProgram.3Thevisits in thiscategoryarealso included inboth theMedicareandtheMedicaidorSCHIPcategories.4Noinsuranceisdefinedashavingonlyself-pay,nocharge,orcharityaspaymentsources.

Table7.Percentdistributionofemergencydepartmentvisitswithcorrespondingstandarderrors,by immediacywithwhichpatientshouldbeseenaccordingtoselectedpatientandvisitcharacteristics:UnitedStates,2007

Numberofvisits in Unknownor

Patientandvisitcharacteristics thousands Total Immediate1 Emergent2 Urgent3 Semiurgent4 Nonurgent5 notriage6Percentdistribution(standarderrorofpercent)

All visits . . . . . . . . . . . . . . . . . . . . . 116,802 100.0 4.5 (0.6) 11.3 (0.7) 38.5 (1.4) 21.0 (1.1) 7.9 (0.7) 16.9 (2.0)Age

Under15years. . . . . . . . . . . . . . . . . 22,308 100.0 2.3 (0.6) 8.2 (0.9) 33.2 (2.5) 26.0 (2.2) 8.6 (1.0) 21.6 (4.2)Under1year. . . . . . . . . . . . . . . . . 3,766 100.0 3.5 (0.9) 9.6 (1.5) 32.6 (3.3) 23.9 (3.0) 8.5 (1.2) 21.9 (5.3)14years. . . . . . . . . . . . . . . . . . . 8,340 100.0 *2.4 (0.7) 7.8 (1.1) 32.4 (2.7) 24.4 (2.5) 8.0 (1.1) 25.1 (4.5)514years . . . . . . . . . . . . . . . . . . 10,202 100.0 *1.9 (0.6) 8.2 (0.9) 34.0 (2.4) 28.1 (2.0) 9.2 (1.1) 18.7 (3.7)

1524years. . . . . . . . . . . . . . . . . . . 18,983 100.0 3.2 (0.6) 9.3 (0.9) 37.3 (1.8) 23.7 (1.4) 9.3 (0.9) 17.3 (2.2)2544years. . . . . . . . . . . . . . . . . . . 33,485 100.0 3.6 (0.5) 10.7 (0.8) 39.8 (1.5) 21.4 (1.2) 9.2 (0.9) 15.2 (1.8)4564years. . . . . . . . . . . . . . . . . . . 24,491 100.0 5.4 (0.7) 13.2 (0.8) 40.4 (1.4) 19.3 (1.1) 6.8 (0.7) 15.0 (1.7)65yearsandover . . . . . . . . . . . . . . . 17,535 100.0 8.8 (1.2) 15.7 (1.0) 41.5 (1.7) 13.1 (1.0) 4.4 (0.6) 16.5 (2.2)

6574years . . . . . . . . . . . . . . . . . 6,908 100.0 8.4 (1.2) 14.0 (1.3) 42.0 (1.9) 15.5 (1.4) 4.9 (0.7) 15.1 (2.1)75yearsandover. . . . . . . . . . . . . . 10,627 100.0 9.1 (1.3) 16.8 (1.2) 41.2 (2.0) 11.6 (1.1) 4.0 (0.6) 17.4 (2.3)

SexFemale . . . . . . . . . . . . . . . . . . . . . . 63,170 100.0 4.0 (0.6) 10.9 (0.7) 39.8 (1.5) 20.7 (1.1) 7.6 (0.7) 17.0 (2.0)Male . . . . . . . . . . . . . . . . . . . . . . . 53,632 100.0 5.0 (0.7) 11.7 (0.7) 36.9 (1.4) 21.4 (1.1) 8.2 (0.8) 16.8 (2.0)

Race710Reported . . . . . . . . . . . . . . . . . . . . . 99,455 100.0 4.5 (0.7) 11.8 (0.7) 39.3 (1.4) 21.1 (1.2) 8.1 (0.8) 15.2 (1.8)Imputed (missing) . . . . . . . . . . . . . . . 17,347 100.0 4.2 (0.9) 8.4 (1.2) 34.2 (3.8) 20.4 (2.1) 6.3 (1.1) *26.5 (5.9)

Reportedplus imputedWhite . . . . . . . . . . . . . . . . . . . . . . . 85,171 100.0 4.6 (0.6) 11.4 (0.7) 38.6 (1.4) 20.3 (1.1) 7.6 (0.7) 17.5 (2.0)Black or African American . . . . . . . . . . 27,870 100.0 4.1 (0.8) 10.8 (1.0) 38.2 (2.0) 23.1 (1.7) 9.0 (1.2) 14.8 (2.7)Other . . . . . . . . . . . . . . . . . . . . . . . 3,762 100.0 2.8 (0.6) 11.1 (1.6) 39.1 (2.0) 21.6 (2.7) 5.4 (1.0) 20.0 (4.2)

ReportedonlyWhite . . . . . . . . . . . . . . . . . . . . . . . 73,001 100.0 4.6 (0.7) 12.0 (0.8) 39.3 (1.4) 20.4 (1.1) 7.8 (0.8) 15.9 (1.9)Black or African American . . . . . . . . . . 23,513 100.0 4.3 (0.9) 11.1 (1.0) 39.1 (2.3) 23.2 (2.0) 9.4 (1.4) 13.0 (2.7)Other . . . . . . . . . . . . . . . . . . . . . . . 2,941 100.0 3.2 (0.7) 12.3 (1.7) 39.1 (2.1) 22.1 (2.8) 5.8 (1.1) 17.4 (3.4)

Ethnicity7,8,11,12Reported . . . . . . . . . . . . . . . . . . . . . 87,702 100.0 4.5 (0.7) 10.9 (0.7) 40.3 (1.5) 21.5 (1.2) 8.4 (0.9) 14.5 (1.8)Imputed (missing) . . . . . . . . . . . . . . . 29,100 100.0 4.3 (0.8) 12.5 (1.7) 33.1 (2.4) 19.5 (1.9) 6.3 (0.8) 24.3 (4.4)Seefootnotesatendoftable.


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Page12 NationalHealthStatisticsReports n Number26 n August6,2010Table7.Percentdistributionofemergencydepartmentvisitswithcorrespondingstandarderrors,by immediacywithwhichpatientshouldbeseenaccordingtoselectedpatientandvisitcharacteristics:UnitedStates,2007Con.

Numberofvisits in Unknownor

Patientandvisitcharacteristics thousands Total Immediate1 Emergent2 Urgent3 Semiurgent4 Nonurgent5 notriage6

Reportedplus imputedHispanicorLatino . . . . . . . . . . . . . . . 15,804 100.0 3.2 (0.5) 8.0 (1.0) 37.2 (2.6) 22.6 (1.9) 7.5 (0.8) 21.5 (3.9)NotHispanicorLatino. . . . . . . . . . . . . 100,998 100.0 4.6 (0.7) 11.8 (0.7) 38.7 (1.4) 20.7 (1.1) 7.9 (0.8) 16.2 (1.9)

ReportedonlyHispanicorLatino . . . . . . . . . . . . . . . 12,202 100.0 3.3 (0.5) 6.9 (0.9) 38.4 (3.0) 23.1 (2.0) 8.3 (1.0) 20.1 (3.9)NotHispanicorLatino. . . . . . . . . . . . . 75,500 100.0 4.7 (0.8) 11.5 (0.7) 40.6 (1.4) 21.2 (1.3) 8.4 (0.9) 13.6 (1.8)

Expectedsourcesofpayment13Private insurance. . . . . . . . . . . . . . . . 45,580 100.0 4.0 (0.5) 12.3 (0.8) 40.1 (1.5) 20.8 (1.2) 6.9 (0.7) 15.9 (1.8)MedicaidorSCHIP14 . . . . . . . . . . . . . 29,379 100.0 3.8 (0.7) 11.7 (1.0) 38.5 (1.7) 22.5 (1.6) 8.5 (0.9) 15.0 (2.2)Medicare . . . . . . . . . . . . . . . . . . . . . 20,133 100.0 8.4 (1.1) 15.7 (1.0) 40.3 (1.5) 14.4 (1.0) 5.3 (0.6) 15.9 (2.0)

MedicareandMedicaid15 . . . . . . . . . 3,478 100.0 7.0 (1.4) 16.7 (1.6) 40.2 (2.5) 14.3 (1.7) 6.7 (1.2) 15.1 (2.7)No insurance16 . . . . . . . . . . . . . . . . . 17,926 100.0 4.2 (0.6) 8.9 (0.8) 37.3 (2.0) 22.7 (1.6) 10.0 (1.1) 17.1 (2.5)Workerscompensation. . . . . . . . . . . . 1,823 100.0 * * 9.6 (1.6) 33.9 (3.5) 25.8 (2.7) 10.4 (2.1) 16.7 (3.2)Other . . . . . . . . . . . . . . . . . . . . . . . 2,764 100.0 *8.7 (3.0) 11.7 (1.6) 32.5 (3.0) 19.7 (2.7) 8.9 (1.7) 18.5 (3.1)Unknownorblank . . . . . . . . . . . . . . . 10,484 100.0 3.4 (0.9) 7.8 (1.2) 32.8 (4.9) 19.4 (2.9) 8.4 (1.9) *28.2 (8.8)*Figuredoesnotmeetstandardsofreliabilityorprecision.1Avisit inwhichthepatientshouldbeseen in less than1minute.2Avisit inwhichthepatientshouldbeseen in114minutes.3Avisit inwhichthepatientshouldbeseenwithin1560minutes.4Avisit inwhichthepatientshouldbeseenwithin61120minutes.5Avisit inwhichthepatientshouldbeseenwithin121minutes24hours.6Avisit inwhichthereisnomentionof triage levelor immediacyrating in themedicalrecord,thehospitaldidnotperform triage,or thepatientwasdead on arrival. 7Otherrace includesAsian,NativeHawaiianorOtherPacific Islander, American IndianorAlaskaNative,andpersonsofmultipleraces.Allracecategories includevisitsbypersonsofHispanicoriginandnotHispanicorigin.PersonsofHispanicoriginmaybeofanyrace.Startingwithdatayear1999,race-specificestimateshavebeen tabulatedaccordingto1997StandardsforFederalDataonRaceandEthnicityandarenotstrictlycomparablewithestimatesforearlieryears.Thepercentageofvisitrecordswithmultipleraces indicated issmallandlowerthanwhat is typicallyfound forself-reportedrace.8For2007,racedataweremissing for14.9percentofvisits,andethnicitydataweremissing for24.9percentofvisits.Readersare thereforeadvisedto treat thesedatawithcaution. Inthis table,estimatesbasedon imputedraceandethnicitydataareshownseparatelyfromcomparisonestimatesusingunimputeddata.Missingraceandethnicitywere imputedusingahotdeckapproachratherthanthepreviouslyusedcolddeckstrategy. Theimputationprocessisdescribedmorefullyinthe2007public-usefiledocumentation(http://www.cdc.gov/nchs/ahcd.htm).Researchiscurrentlyunderwaytoevaluatefurtherchanges to the imputationstrategy forusewith2008data.9Reportedplus imputedincludesracethatwasreporteddirectlybyemergencydepartmentsand imputedvaluesforthe14.9percentofvisits forwhichracewasnotreported.10Reportedonlycalculationsarebasedon99,455,000visitswithracereporteddirectlybyemergencydepartments.Thevisitsforwhichracewasmissingareexcluded from thedenominator, sothatreaderscancomparedifferencesbetweenestimates that includeandexclude imputedracevalues.11Reportedplus imputedincludesethnicitythatwasreporteddirectlybyemergencydepartmentsand imputedvalues forthe24.9percentofvisits forwhichethnicitywasnotreported.12Reportedonlycalculationsarebasedon87,702,000visitswithethnicityreporteddirectlybyemergencydepartments.Thevisits forwhichethnicitywasmissingareexcluded fromthedenominatorsothatreaderscancomparedifferencesbetweenestimates that includeandexclude imputedethnicityvalues.13Totalexceeds allvisitsbecausemorethanonesourceofpaymentmaybereportedpervisit.14SCHIPistheStateChildrensHealth InsuranceProgram.15Thevisitsinthiscategoryarealsoincluded inboth theMedicareand theMedicaidorSCHIPcategories.16No insuranceisdefinedashavingonlyself-pay,nocharge,orcharityaspaymentsources.NOTE:Numbersmaynotadd to totalsbecauseofrounding.
http://www.cdc.gov/nchs/ahcd.htmhttp://www.cdc.gov/nchs/ahcd.htmhttp://www.cdc.gov/nchs/ahcd.htmhttp://www.cdc.gov/nchs/ahcd.htmhttp://www.cdc.gov/nchs/ahcd.htmhttp://www.cdc.gov/nchs/ahcd.htmhttp://www.cdc.gov/nchs/ahcd.htmhttp://www.cdc.gov/nchs/ahcd.htmhttp://www.cdc.gov/nchs/ahcd.htmhttp://www.cdc.gov/nchs/ahcd.htmhttp://www.cdc.gov/nchs/ahcd.htmhttp://www.cdc.gov/nchs/ahcd.htmhttp://www.cdc.gov/nchs/ahcd.htmhttp://www.cdc.gov/nchs/ahcd.htmhttp://www.cdc.gov/nchs/ahcd.htmhttp://www.cdc.gov/nchs/ahcd.htmhttp://www.cdc.gov/nchs/ahcd.htm


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National Health Statistics Reports n Number 26 n August 6, 2010 Page 13Table8.Numberandpercentdistributionofemergencydepartmentvisitswithcorrespondingstandarderrors,byinitialvitalsigns,episodeofcare,priorvisits,andpriorhospitaldischarges:UnitedStates,2007

Visit characteristicNumber of

visits inthousands

(Standarderror in

thousands) Percentdistribution(Standard

error ofpercent)

A ll vi sits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116,802 (6,293) 100.0 . . .Temperature

Febrile: >38.0 C or >10 0.4 F . . . . . . . . . . . . . . . . . . . . . . . . . . . Normal: 35.138.0 C or 95.1100.4 F . . . . . . . . . . . . . . . . . . . . . Hypothermic: :


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Page 14 National Health Statistics Reports n Number 26 n August 6, 2010Table9.Numberandpercentdistributionofvisitswithcorrespondingstandarderrors,bythe10leadingprincipalreasonsforemergencydepartmentvisits,accordingtoageandsex:UnitedStates,2007Con.

Number of (Standard (Standardvisits in error Percent error

Principal reason for visit and RVC code1 thousands in thousands) distribution of percent)Ma l e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12,236 (1,047) 54.8 (0.9)

Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S 0 1 0 1,888 (212) 8.5 (0.5)Cough . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S440

876

(106)

3.9

(0.3)

Vomiting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S530 668 (96) 3.0 (0.3) Injury, other and unspecified typehead, neck, and face . . . . . .J505 442 (70) 2.0 (0.3)Earache or ear infection . . . . . . . . . . . . . . . . . . . . . . . . . .S355 440 (68) 2.0 (0.3)Facial area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J2 1 0 368 (44) 1.7 (0.2)Skin rash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S860 350 (50) 1.6 (0.2) Stomach pain, cramps, and spasms . . . . . . . . . . . . . . . . . .S545 306 (40) 1.4 (0.1) Symptoms referable to throat. . . . . . . . . . . . . . . . . . . . . . .S455 234 (38) 1.1 (0.2) Labored or difficult breathing (dyspnea) . . . . . . . . . . . . . . . .S420 220 (44) 1.0 (0.2)All other reasons2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,445 (594) 28.9 (0.9)

All visits, age 1564 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76,959 (4,249) 100.0 . . .F e ma l e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42,559 (2,372) 55.3 (0.6)

Stomach pain, cramps, and spasms . . . . . . . . . . . . . . . . . .S545 4,585 (331) 6.0 (0.3)Chest pain and related symptoms . . . . . . . . . . . . . . . . . . . .S050 2,285 (187) 3.0 (0.2)Headache, pain in head . . . . . . . . . . . . . . . . . . . . . . . . . .S210 1,784 (137) 2.3 (0.1)Back symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S905 1,460 (142) 1.9 (0.1)Problems of pregnancy and the post-partum period . . . . . . . . .S790 1,303 (130) 1.7 (0.1)Pain, site not referable to a specific body system . . . . . . . . . .S055 1,260 (109) 1.6 (0.1)Symptoms referable to throat. . . . . . . . . . . . . . . . . . . . . . .S455 949 (98) 1.2 (0.1) Shortness of breath. . . . . . . . . . . . . . . . . . . . . . . . . . . . .S415 905 (84) 1.2 (0.1) Nausea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S525 815 (102) 1.1 (0.1)Uterine and vaginal bleeding . . . . . . . . . . . . . . . . . . . . . . .S755 759 (79) 1.0 (0.1)All other reasons2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26,453 (1,443) 34.4 (0.4)

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34,400 (1,963) 44.7 (0.6)Chest pain and related symptoms . . . . . . . . . . . . . . . . . . . .S050 2,159 (187) 2.8 (0.2)Stomach pain, cramps, and spasms . . . . . . . . . . . . . . . . . .S545 2,031 (148) 2.6 (0.1)Back symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S905 1,273 (113) 1.7 (0.1) Pain, site not referable to a specific body system . . . . . . . . . .S055 1,219 (117) 1.6 (0.1)Headache, pain in head . . . . . . . . . . . . . . . . . . . . . . . . . .S210 1,004 (117) 1.3 (0.1)Lacerations and cutsupper extremity . . . . . . . . . . . . . . . . .J225 971 (88) 1.3 (0.1)Shortness of breath. . . . . . . . . . . . . . . . . . . . . . . . . . . . .S415 669 (64) 0.9 (0.1) Symptoms referable to throat. . . . . . . . . . . . . . . . . . . . . . .S455 639 (74) 0.8 (0.1) Low back symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . .S910 633 (71) 0.8 (0.1) Leg symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S920 589 (69) 0.8 (0.1) All other reasons2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23,213 (1,332) 30.2 (0.5)

All visits, age 65 years and over . . . . . . . . . . . . . . . . . . . . . . . . . 17,535 (1,014) 100.0 . . .F e ma l e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,539 (643) 60.1 (0.8)

Chest pain and related symptoms . . . . . . . . . . . . . . . . . . . .S050 894 (92) 5.1 (0.4)Shortness of breath. . . . . . . . . . . . . . . . . . . . . . . . . . . . .S415 666 (91) 3.8 (0.4) Stomach pain, cramps, and spasms . . . . . . . . . . . . . . . . . .S545 629 (66) 3.6 (0.3)Accident, not otherwise specified. . . . . . . . . . . . . . . . . . . . .J810 379 (56) 2.2 (0.3)General weakness . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S 02 0 374 (49) 2.1 (0.3)Vertigodizziness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S225 276 (36) 1.6 (0.2) Nausea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S525 256 (39) 1.5 (0.2)Labored or difficult breathing (dyspnea) . . . . . . . . . . . . . . . .S420 246 (44) 1.4 (0.2) Leg symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S920 242 (39) 1.4 (0.2) Cough . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S440 223 (35) 1.3 (0.2)All other reasons2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,354 (389) 36.2 (0.9)

Ma l e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,996 (414) 39.9 (0.8)Chest pain and related symptoms . . . . . . . . . . . . . . . . . . . .S050 585 (56) 3.3 (0.3)Shortness of breath. . . . . . . . . . . . . . . . . . . . . . . . . . . . .S415 439 (54) 2.5 (0.3) Stomach pain, cramps, and spasms . . . . . . . . . . . . . . . . . .S545 391 (57) 2.2 (0.3)General weakness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S 0 2 0 266 (41) 1.5 (0.2)Vertigodizziness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S225 218 (34) 1.2 (0.2) Other urinary dysfunctions. . . . . . . . . . . . . . . . . . . . . . . . .S660 161 (32) 0.9 (0.2) Accident, not otherwise specified. . . . . . . . . . . . . . . . . . . . .J810 144 (30) 0.8 (0.2)Labored or difficult breathing (dyspnea) . . . . . . . . . . . . . . . .S420 140 (32) 0.8 (0.2)Lacerations and cutsupper extremity . . . . . . . . . . . . . . . . .J225 138 (35) 0.8 (0.2)Abnormal pulsations and palpitations . . . . . . . . . . . . . . . . . .S260 124 (36) 0.7 (0.2)All other reasons2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,390 (277) 25.0 (0.7)

. . . Category not applicable. 1Based on A Reason for Visit Classification for Ambulatory Care (RVC)(13).2Category includes all other reasons not listed above as well as unknown and blanks.NOTE: Numbers may not add to totals because of rounding.


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NationalHealthStatisticsReports n Number26 n August6,2010 Page15Table10.Numberandpercentdistributionofemergencydepartmentvisitswithcorrespondingstandarderrors,bythe10 leadingprimarydiagnosisgroups,accordingtoageandsex:UnitedStates,2007

Number (Standard (Standardofvisits error Percent errorof

PrimarydiagnosisgroupandICD9CMcode(s)1 inthousands inthousands) distribution percent)All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116,802 (6,293) 100.0 ...Allvisits,ageunder15ye a rs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22,308 (1,864) 100.0 ...Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,072 (859) 45.2 (0.9)

Acuteupperrespiratory infections,excludingpharyngitis . . . . .460461,463466 929 (137) 4.2 (0.5)OtitismediaandEustachiantubedisorders . . . . . . . . . . . . . . . . . . .381382 614 (92) 2.8 (0.3)UnspecifiedviralandChlamydia infection . . . . . . . . . . . . . . . . . . . . . .079.9 503 (124) 2.3 (0.4)Contusion with intact skin surface . . . . . . . . . . . . . . . . . . . . . . . . .920924 451 (63) 2.0 (0.3)Pyrexiaofunknownorigin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 80 .6 433 (67) 1.9 (0.3)Openwoundofhead. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 0 87 3 370 (55) 1.7 (0.2)Acutepharyngitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 6 2 357 (45) 1.6 (0.2) Abdominalpain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 8 9 . 0 307 (58) 1.4 (0.2)Noninfectious enteritis and colitis . . . . . . . . . . . . . . . . . . . . . . . . .555558 264 (62) 1.2 (0.3)Fractures,excluding lower l imb. . . . . . . . . . . . . . . . . . . . . . . . . . .800819 204 (45) 0.9 (0.2)Allotherdiagnoses2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,640 (482) 25.3 (0.7)

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12,236 (1,047) 54.8 (0.9)Acuteupperrespiratory infections,excludingpharyngitis . . . . .460461,463466 1,250 (174) 5.6 (0.6)OtitismediaandEustachiantubedisorders . . . . . . . . . . . . . . . . . . .381382 946 (120) 4.2 (0.4)Openwoundofhead. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 0 87 3 651 (71) 2.9 (0.3)Contusion with intact skin surface . . . . . . . . . . . . . . . . . . . . . . . . .920924 583 (61) 2.6 (0.3)Pyrexiaofunknownorigin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 80 .6 541 (62) 2.4 (0.2)Openwound,excludinghead. . . . . . . . . . . . . . . . . . . . . . . . . . . .874897 434 (63) 1.9 (0.2)Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 9 3 375 (62) 1.7 (0.2) Fractures,excluding lower l imb. . . . . . . . . . . . . . . . . . . . . . . . . . .800819 364 (47) 1.6 (0.2)UnspecifiedviralandChlamydia infection . . . . . . . . . . . . . . . . . . . . . .079.9 351 (48) 1.6 (0.2)Acutepharyngitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 6 2 292 (38) 1.3 (0.2) Allotherdiagnoses2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,450 (618) 28.9 (0.9)

Allvisits,age1564years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76,959 (4,249) 100.0 ...Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42,559 (2,372) 55.3 (0.6)

Abdominalpain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 8 9 . 0 2,597 (225) 3.4 (0.2)Complicationsofpregnancy,childbirth,andthepuerperium . . . . . . . . .630677 1,794 (145) 2.3 (0.2)Chestpain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 8 6 . 5 1,572 (158) 2.0 (0.2)Contusion with intact skin surface . . . . . . . . . . . . . . . . . . . . . . . . .920924 1,503 (102) 2.0 (0.1)Spinal disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 20 72 4 1,202 (139) 1.6 (0.2)Sprainsandstrainsofneckandback. . . . . . . . . . . . . . . . . . . . . . . .846,847 1,187 (129) 1.5 (0.1)Acute

upper

respiratory

infections,

excluding

pharyngitis

. . . . .460461,463466

1,160

(127)

1.5

(0.1)

Urinarytract infection,sitenotspecified . . . . . . . . . . . . . . . . . . . . . . .599.0 1,124 (104) 1.5 (0.1)Cellulitis andabscess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 81 682 992 (107) 1.3 (0.1)Sprainsandstrains,excludingankleandback. . . . . . . . . . .840844,845.1,848 896 (93) 1.2 (0.1)Allotherdiagnoses2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28,532 (1,579) 37.1 (0.5)

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34,400 (1,963) 44.7 (0.6)Openwound,excludinghead. . . . . . . . . . . . . . . . . . . . . . . . . . . .874897 1,816 (151) 2.4 (0.1)Contusion with intact skin surface . . . . . . . . . . . . . . . . . . . . . . . . .920924 1,425 (120) 1.9 (0.1)Chestpain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 8 6 . 5 1,421 (141) 1.8 (0.1)Cellulitis andabscess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 81 68 2 1,118 (102) 1.5 (0.1)Spinal disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 20 72 4 1,112 (108) 1.4 (0.1)Sprainsandstrains,excludingankleandback. . . . . . . . . . .840844,845.1,848 1,026 (95) 1.3 (0.1)Abdominalpain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 8 9 . 0 1,009 (104) 1.3 (0.1)Sprainsandstrainsofneckandback . . . . . . . . . . . . . . . . . . . . . . .846,847 948 (96) 1.2 (0.1)Fractures,excluding lower l imb. . . . . . . . . . . . . . . . . . . . . . . . . . .800819 911 (85) 1.2 (0.1)Drugdependenceandnondependenceabuseofdrugs. . . . . . . . . . . .304305 690 (74) 0.9 (0.1)Allotherdiagnoses2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22,924 (1,314) 29.8 (0.5)

Allvisits,age65yearsandover. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17,535 (1,014) 100.0 ...Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,539 (643) 60.1 (0.8)

Chestpain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 8 6 . 5 576 (76) 3.3 (0.3)Contusion with intact skin surface . . . . . . . . . . . . . . . . . . . . . . . . .920924 548 (67) 3.1 (0.4)Heartdisease,excluding ischemic.391392.0,393398,402,404,415416,420429 520 (55) 3.0 (0.3)Urinarytract infection,sitenotspecified . . . . . . . . . . . . . . . . . . . . . . .599.0 391 (57) 2.2 (0.3)Abdominalpain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 8 9 . 0 322 (44) 1.8 (0.2)Fractures,excluding lower l imb. . . . . . . . . . . . . . . . . . . . . . . . . . .800819 293 (46) 1.7 (0.2)Cerebrovasculardisease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .430438 266 (41) 1.5 (0.2)Fracture of the lower limb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .820829 233 (41) 1.3 (0.2)Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 80 4 86 232 (39) 1.3 (0.2)Spinal disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 20 72 4 229 (41) 1.3 (0.2)Allotherdiagnoses2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,929 (425) 39.5 (0.9)

Seefootnotesatendoftable.


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Page16 NationalHealthStatisticsReports n Number26 n August6,2010Table10.Numberandpercentdistributionofemergencydepartmentvisitswithcorrespondingstandarderrors,bythe10 leadingprimarydiagnosisgroups,accordingtoageandsex:UnitedStates,2007Con.

Number (Standard (Standardofvisits error Percent errorof

PrimarydiagnosisgroupandICD9CMcode(s)1 inthousands inthousands) distribution percent)Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,996 (414) 39.9 (0.8)

Heartdisease,excluding ischemic.391392.0,393398,402,404,415416,420429 461 (60) 2.6 (0.3)Chest

pain

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 8 6 . 5

422

(46)

2.4

(0.2)

Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 80 4 86 225 (37) 1.3 (0.2)Cellulitisandabscess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 81 68 2 206 (39) 1.2 (0.2)Openwound,excludinghead. . . . . . . . . . . . . . . . . . . . . . . . . . . .874897 197 (42) 1.1 (0.2)Abdominalpain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 8 9 . 0 176 (34) 1.0 (0.2)Cerebrovasculardisease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .430438 171 (32) 1.0 (0.2)Syncopeandcollapse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 0.2 169 (29) 1.0 (0.2)Contusion with intact skin surface . . . . . . . . . . . . . . . . . . . . . . . . .920924 168 (33) 1.0 (0.2)Symptoms involvingtheurinarysystem. . . . . . . . . . . . . . . . . . . . . . . . .788 163 (31) 0.9 (0.2) Allotherdiagnoses2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,638 (285) 26.5 (0.8)

. . . Categorynotapplicable.1Based on the InternationalClassificationofDiseases,NinthRevision,ClinicalModification(ICD9CM)(14).However,certaincodeshavebeencombined in thistable tobetterdescribe theuseofambulatorycareservices.2Categoryincludesallotherdiagnosesnot listedaboveaswellasunknownandblanks.NOTE:Numbersmaynotaddto totalsbecauseofrounding.


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NationalHealthStatisticsReports n Number26 n August6,2010 Page17Table11.Number,percentdistribution,andannualrateofemergencydepartmentvisitswithcorrespondingstandarderrors,by injury,poisoning,oradverseeffectsofmedicaltreatment,accordingtopatientageandsex,hospitalownership,geographicarea,andmetropolitan status:UnitedStates,2007


visits in error in Percent errorof 100persons errorSelectedpatientandhospitalcharacteristics thousands thousands) distribution percent) peryear1 ofrate)

All injury-relatedvisits2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39,395 (2,089) 100.0 ... 13.3 (0.7)Patientcharacteristics

Age:Under15years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,303 (516) 18.5 (0.9) 12.0 (0.8)Under1year. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405 (62) 1.0 (0.1) 9.5 (1.5) 14years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,429 (198) 6.2 (0.4) 14.8 (1.2)514years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,469 (324) 11.3 (0.5) 11.1 (0.8)1524years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,112 (466) 18.1 (0.5) 17.1 (1.1)2544years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,633 (691) 29.5 (0.7) 14.2 (0.8)4564years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,119 (457) 20.6 (0.6) 10.7 (0.6)65yearsandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,227 (328) 13.3 (0.6) 14.4 (0.9)6574years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,963 (148) 5.0 (0.3) 10.3 (0.8)75yearsandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,265 (213) 8.3 (0.4) 19.1 (1.2)

Sexandage:Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18,449 (996) 46.8 (0.6) 12.2 (0.7)

Under15years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,076 (233) 7.8 (0.4) 10.4 (0.8)1524years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,103 (200) 7.9 (0.3) 15.1 (1.0)2544years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,082 (331) 12.9 (0.5) 12.3 (0.8)4564years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,947 (252) 10.0 (0.4) 10.1 (0.6)6574years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,063 (102) 2.7 (0.2) 10.3 (1.0)75yearsandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,178 (161) 5.5 (0.3) 21.0 (1.6)

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20,946 (1,141) 53.2 (0.6) 14.4 (0.8)Under15years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,227 (332) 10.7 (0.6) 13.6 (1.1)1524years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,009 (301) 10.2 (0.4) 19.1 (1.4)2544years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,550 (405) 16.6 (0.5) 16.2 (1.0)4564years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,173 (252) 10.6 (0.4) 11.3 (0.7)6574years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 900 (85) 2.3 (0.2) 10.3 (1.0) 75yearsandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,087 (89) 2.8 (0.2) 16.1 (1.3)

HospitalcharacteristicsOwnership:

Voluntary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29,333 (1,849) 74.5 (3.0) 9.9 (0.6)Proprietary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,206 (1,189) 13.2 (2.7) 1.8 (0.4)Government . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,856 (712) 12.3 (1.9) 1.6 (0.2)

Geographicregion:Northeast. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,248 (654) 18.4 (1.6) 13.5 (1.2)Midwest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,627 (795) 21.9 (1.9) 13.2 (1.2)South . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,541 (1,382) 39.4 (2.7) 14.4 (1.3)West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,980 (1,221) 20.3 (2.6) 11.6 (1.8)

Metropolitan status3MSA4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33,175 (2,129) 84.2 (1.9) 13.3 (0.9)Non-MSA4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,220 (687) 15.8 (1.9) 13.2 (1.5). . . Categorynotapplicable.1Visitrates forage,sex,andregionarebasedon theJuly1,2007,setofestimatesof theciviliannoninstitutionalizedpopulationof theUnitedStatesasdevelopedbythePopulationDivision,U.S.CensusBureau.2Injury-related includes injuries,poisoning,andadverseeffects,accounting for33.7percent(SE=0.6)ofallvisits.3Populationestimatesofmetropolitanstatisticalarea(MSA)statusarebasedonestimatesof theciviliannoninstitutionalizedpopulationof theUnitedStates fromthe2007NationalHeath InterviewSurvey,

National

Center

for

Health

Statistics,

compiled

according

to

the

December

2006

Office

of

Management

and

Budget

definitions

of

core-based

statistical

areas.

See:

http://www.census.gov/

population/www/metroareas/metrodef.html formoreaboutMSAdefinitions.4MSAismetropolitanstatisticalarea.NOTE:Numbersmaynotaddto totalsbecauseofrounding.
http://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.htmlhttp://www.census.gov/population/www/metroareas/metrodef.htmlhttp://w

national hospital ambulatory medical care survey: 2007 emergency department summary

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