Age Cutoffs for Hospitalization at Hospitals Without Pediatric Inpatient Capability

Abstract

OBJECTIVES: To determine age cutoffs that hospitals without pediatric inpatient beds apply when hospitalizing children. METHODS: We conducted a cross-sectional study of patients <25 years old visiting emergency departments in 5 states in 2016 using the Healthcare Cost and Utilization Project State Emergency Department and Inpatient Databases. Hospitals were classified as adult (no pediatric inpatient beds) or pediatric capable (>0 pediatric beds). Referral rates were calculated for each year of life as transfers divided by transfers plus hospitalizations. Two age cutoffs were determined for defining pediatric patients: a specific cutoff (the age at which referral rates were significantly lower than those for younger patients) and an inclusive cutoff (the age at which referral rates differed most from those for younger patients). RESULTS: Among 389 581 transfers and hospitalizations, 91 967 (23.6%) occurred in adult hospitals. Referral rates at adult hospitals were 86.0% at age 15, 80.6% at age 16, 72.0% at age 17, and 30.5% at age 18. The specific age cutoff was 16 because referral rates were lower than those for ages 0 to 15 (P < .001). The inclusive age cutoff was 18 because the odds ratio for referral was lowest when comparing age 18 to ages 0 to 17. CONCLUSIONS: Children aged <16 years specifically define a population of pediatric patients, as defined by whether an adult hospital would hospitalize instead of transfer from an emergency department. Children aged <18 years inclusively define a population of pediatric patients. These age cutoffs may be used when studying patterns of national acute care for children.