Trajectories of emergency department use among adolescents and young adults with sickle cell disease in North Carolina
Objectives: Emergency department (ED) utilization among transition age adolescents and young adults (AYAs, 14-30 years old) with SCD is linked to morbidity and mortality. We describe age-related ED utilization and associations with sociodemographic characteristics among AYAs with SCD in North Carolina (NC). Methods: This observational study used the NC Hospital Discharge data (2014-2019). We conducted latent growth class analysis to identify distinct ED utilization trajectories by age and bivariate analyses to explore associations between ED utilization classes and sociodemographic factors. Results: During the study, 3614 AYAs with SCD (54% female; 96% Black) had 39 585 ED visits. The mean number of annual ED visits was 1.23 at age 14, peaking at 5.35 at age 24, and declining to 4.64 at age 30. Three classes of ED utilization trajectories were identified: low [95.2%, mean (SD) annual visits = 2.29 (2.55)], medium [4.1%, mean (SD) annual visits = 20.38 (7.42)], and high [0.7%, mean (SD) annual visits = 47.71 (18.58)]. Despite similar utilization at age 14, medium and high utilization groups had respectively 10 and 20 times the ED utilization of the low utilization group and had visits at multiple EDs. Social vulnerability was not associated with ED utilization. Conclusion: A small fraction of AYAs drive most ED utilization, with significant increases observed during transition. These results underscore the necessity for resources and tailored interventions to enhance care continuity during transition. Further research should identify modifiable factors influencing ED visits and develop strategies to improve transition care.
