Influence of school enrollment on adolescent emergency department visits.

PURPOSE: This study examined the influence of school enrollment on the spectrum of adolescent problems seen in emergency department. METHODS: Medical charts of all adolescent patients presenting to an urban general emergency department for 2 years (1991-1993) were retrospectively reviewed. Data obtained included date, time, and means of arrival, triage acuity score, primary diagnosis with disposition, and whether enrolled in school. RESULTS: Of 3,269 charts reviewed, 36% of visits were the result of injuries and 64% owing to acute medical complaints. Of all visits, 7% were for sexually related complaints. A total of 86% of adolescent patients had no medical insurance or federal assistance. Based on emergency department triage criteria, 40% of all visits were judged nonemergency. Ambulance arrivals accounted for 4%, admissions 4%, and those not currently enrolled in school 40%. Adolescents not enrolled in school had a similar spectrum of medical illnesses and significantly more injuries (45% vs. 30%), and were triaged as emergency (8% vs. 4%) or nonemergency (48% vs. 34%) significantly more often than adolescents enrolled in school. There were no significant differences by sex or race. CONCLUSIONS: Adolescents use the emergency department as a source of primary care and injury treatment. Adolescents presenting to the emergency department who are not enrolled in school have significant differences in diagnosis and severity of illness compared with adolescents enrolled in school. General emergency departments must be prepared to deal with the unique needs of all adolescents, especially those not enrolled in school, including nonemergency primary care and injury management.