Abstract
BACKGROUND: Every year, thousands of children use the emergency department (ED) for low-acuity conditions. This study aimed to determine the financial impact of ED utilization for the most common nonemergent ocular conditions, blepharitis and conjunctivitis, and to explore the demographics of patients seeking care for these conditions through the ED. METHODS: All cases of pediatric blepharitis and conjunctivitis between January 1, 2012, and December 31, 2021, were identified using the California Office of Health Care Access Information Database. Cases were analyzed under different billing structures including care rendered in the emergency department (ED) versus outpatient settings using evaluation and management (E&M) and eye visit codes. RESULTS: Blepharitis and conjunctivitis accounted for 306,417 visits, or 78.2% of all ED eye-related visits among children ≤18 years. The most common self-reported race/ethnicity was Hispanic (56.3%), followed by White (20.1%) and Black (13.0%). Most patients had public insurance (72.7%) or private insurance (19.7%). ED utilization was 17.6% higher during weekends. Estimated costs for ED visits totaled $36,567,192-$37,914,508 annually. Estimated annual outpatient costs using new patient E&M codes totaled $1,146,612- $2,303,337, and the estimated annual outpatient costs using eye visit codes totaled $1,138,339-1,525,344. This suggests the cost of ED care was 16.5-32.1 times more expensive than equivalent outpatient costs. CONCLUSIONS: Care provided in the ED for blepharitis and conjunctivitis may be 16.5-32.1 times more expensive than care rendered in outpatient settings. Non-White children and children with public insurance had higher ED utilization compared to their population-level representation. Increasing access to pediatric eye specialists and decreasing ED utilization has the potential to improve efficacy while promoting childhood health outcomes.