Series 13

No. 125

National Hospital Ambulatory

Medical Care Survey: 1992

Emergency Department

Summary

March 1997

Vital and

Health Statistics

From the CENTERS FOR DISEASE CONTROL AND PREVENTION / National Center for Health Statistics

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics
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The use of trade names is for identification only and does not imply

endorsement by the Public Health Service, U.S. Department of Health and

Human Services.

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reproduced or copied without permission; citation as to source, however, is

appreciated.

Suggested citation

Schappert SM. National Hospital Ambulatory Medical Care Survey: 1992

emergency department summary. National Center for Health Statistics. Vital

Health Stat 13(125). 1997.

Library of Congress Cataloging-in-Publication Data

National Hospital Ambulatory Medical Care Survey : 1992 emergency

department summary.

p. cm. — (Vital and health statistics. Series 13, Data from the National

Health Survey ; no. 125) (DHHS publication ; no. (PHS) 96-1786)

‘‘Based on data collected from a national sample of non-Federal, general or

short-stay hospitals, statistics are presented on the provision and utilization of

ambulatory medical care services in hospital emergency departments during

1992. Ambulatory medical care services are described in terms of patient

characteristics, visit characteristics, and facility characteristics.’’

‘‘August 1996.’’

Includes bibliographical references.

ISBN 0-8406-0519-6

1. National Hospital Ambulatory Medical Care Survey (U.S.)

2. Hospitals—Emergency service—Utilization—United States—Statistics.

3. Hospitals—Emergency service—United States—Statistics. 4. United

States—Statistics, Medical. I. National Center for Health Statistics (U.S.)

II. Series. III. Series: DHHS publication ; no. (PHS) 96-1786.

[DNLM: 1. National Hospital Ambulatory Medical Care Survey (U.S.)

2. Ambulatory Care—utilization—United States—statistics. 3. Emergency

Service, Hospital—utilization—United States—statistics. W2 A N148vm no. 125

1996]

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Washington, DC 20402-9328
National Hospital Ambulatory

Medical Care Survey: 1992

Emergency Department

Summary

Series 13:

Data From the National Health Care Survey

No. 125

Based on data collected from a national sample of non-Federal, general or

short-stay hospitals, statistics are presented on the provision and utilization of

ambulatory medical care services in hospital emergency departments

during 1992. Ambulatory medical care services are described in terms of

patient characteristics, visit characteristics, and facility characteristics.

Hyattsville, Maryland

March 1997

DHHS Publication No. (PHS) 96-1786

Vital and

Health Statistics

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics
National Center for Health Statistics

Edward J. Sondik, Ph.D., Director

Jack R. Anderson, Deputy Director

Jack R. Anderson, Acting Associate Director for

International Statistics

Lester R. Curtin, Ph.D., Acting Associate Director for

Research and Methodology

Jacob J. Feldman, Ph.D., Associate Director for Analysis,

Epidemiology, and Health Promotion

Gail F. Fisher, Ph.D., Associate Director for Data Standards,

Program Development, and Extramural Programs

Edward L. Hunter, Associate Director for Planning, Budget,

and Legislation

Jennifer H. Madans, Ph.D., Acting Associate Director for

Vital and Health Statistics Systems

Stephen E. Nieberding, Associate Director for

Management

Charles J. Rothwell, Associate Director for Data

Processing and Services

Division of Health Care Statistics

W. Edward Bacon, Ph.D., Director

Thomas McLemore, Deputy Director

Catharine W. Burt, Ed.D., Chief, Ambulatory Care

Statistics Branch

Malcolm C. Graham, Acting Chief, Technical

Services Branch
Abstract

Objective—This report presents data on the provision and

utilization of ambulatory medical care services in hospital

emergency departments during 1992. Ambulatory medical

care services are described in terms of patient, visit, and

facility characteristics. Among these are the patient’s reason

for the visit, diagnostic and screening services ordered or

provided, diagnosis, and medications provided or prescribed.

Cause of injury data are presented for injury-related visits.

Methods—Data presented in this report are from the 1992

National Hospital Ambulatory Medical Care Survey

(NHAMCS), a national survey of non-Federal, general and

short-stay hospitals, conducted by the Division of Health Care

Statistics, National Center for Health Statistics, Centers for

Disease Control and Prevention. This report reflects the survey’s first year of data collection. A four-stage probability

sample design was used, resulting in a sample of 524 nonFederal, general and short-stay hospitals. Ninety-two percent

of eligible facilities participated in the survey. Hospital staff

were asked to complete Patient Record forms for a systematic

random sample of patient visits occurring during a randomly

assigned 4-week reporting period, and 36,271 forms were

completed by participating emergency departments. Diagnosis

and cause of injury were coded according to the International

Classification of Diseases, 9th Revision, Clinical Modification

(ICD–9–CM). Reason for visit and medications were coded

according to systems developed by the National Center for

Health Statistics.

Results—An estimated 89.8 million visits were made to

the emergency departments of non-Federal, general and shortstay hospitals in the United States during 1992—357.1 visits

per 1,000 persons. Persons 75 years of age and over had a

higher visit rate than persons in five other age categories.

White persons accounted for 78.5 percent of all visits. However, the visit rate for black persons was significantly higher

than for white persons overall and for every age category

except 65–74 years and 75 years and over. More than half of

all visits were illness related and more than one-third were

injury related. Stomach and abdominal pain and chest pain

were the most frequently mentioned reasons for visiting the

emergency department, accounting for about five million visits

each, or 10.7 percent of the total. Accidental falls accounted for

the largest share of injury-related visits (22.7 percent).

Keywords: Utilization v Injury v Diagnoses v ICD–9–CM

iii
Contents

Introduction............................................................................................ 1

Source and limitations of the data .......................................................................... 2

Data highlights ......................................................................................... 3

Visits to hospital emergency departments ................................................................... 4

Age, sex, and race of patients .......................................................................... 4

Geographic region of visit ............................................................................. 4

Major reason for visit as reported by hospital staff ......................................................... 5

Patient’s principal reason for visit ....................................................................... 6

Injury-related visits ................................................................................... 7

Alcohol- and drug-related visits ......................................................................... 8

Diagnostic and screening services ....................................................................... 8

Principal diagnosis ................................................................................... 9

Procedures .......................................................................................... 9

Medication therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Providers seen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Expected source of payment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Visit disposition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Facility characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Urgency of visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

List of detailed tables. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Text tables

A. Number, percent distribution, and annual rate of emergency department visits by whether visit was injury related:

United States, 1992 ................................................................................ 5

B. Number, percent distribution, and annual rate of emergency department visits by whether visit was alcohol and/or

drug related: United States, 1992 ..................................................................... 8

C. Number of occurrences and percent of all drug mentions by the 20 most frequent generic substances in drug

mentions at emergency department visits: United States, 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

D. Number, percent distribution, and therapeutic classification of the 20 drugs most often mentioned at emergency

department visits, by entry name of drug: United States, 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Text figures

1. Annual rate of emergency department visits by patient’s age and race: United States, 1992 ...................... 4

2. Annual rate of emergency department visits by patient’s age and major reason for visit: United States, 1992 ....... 5

3. Annual rate of emergency department visits by patient’s race and major reason for visit: United States, 1992 ....... 6

4. Percent distribution of emergency department visits by patient’s principal reason for visit: United States, 1992 ...... 6

5. Annual rate of injury-related emergency department visits by the most frequent principal causes of injury and

patient’s race: United States, 1992 .................................................................... 8

6. Percent of emergency department visits by major reason for visit, according to selected diagnostic and screening

services ordered or provided: United States, 1992 ........................................................ 9

7. Percent distribution of emergency department visits by principal diagnosis: United States, 1992 .................. 9

v
8. Percent of emergency department visits by major reason for visit, according to providers seen:

United States, 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

9. Percent of emergency department visits by major reason for visit, according to expected source of payment:

United States, 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

10. Percent of emergency department visits by major reason for visit, according to disposition of visit:

United States, 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

11. Annual rate of emergency department visits by patient’s race, according to location of hospital:

United States, 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

12. Annual rate of urgent emergency department visits by patient’s age and race: United States, 1992 . . . . . . . . . . . . . . . . 13

13. Percent of urgent and nonurgent emergency department visits by disposition of visit: United States, 1992 . . . . . . . . . . 13

14. Percent of urgent illness- and injury-related emergency department visits by disposition of visit:

United States, 1992. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Appendixes

I. Technical notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

II. Definition of terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

III. Survey instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

vi
National Hospital

Ambulatory Medical Care

Survey: 1992 Emergency

Department Summary

by Susan M. Schappert, M.A.

Division of Health Care Statistics

Introduction

This report presents national estimates of the utilization of

ambulatory medical care services provided by hospital-based

emergency departments in the United States during 1992. The

estimates are based on data from the National Hospital

Ambulatory Medical Care Survey (NHAMCS), a probability

sample survey conducted by the Division of Health Care

Statistics of the National Center for Health Statistics, Centers

for Disease Control and Prevention.

The NHAMCS was inaugurated in December 1991 to gather

and disseminate information about the health care provided by

hospital emergency and outpatient departments in the United

States. This report presents a broad summary of data from

hospital emergency departments from the survey’s first year

(1992) of operation. Several reports that present highlights from

the 1992 NHAMCS data have already been published (1–4), and

additional reports on special topics are scheduled for publication.

This report describes the utilization of hospital-based emergency departments (ED’s) in terms of patient and visit characteristics. Some data on facility characteristics are also included. The

report concludes with a series of appendixes that contain technical information pertaining to the 1992 NHAMCS. Included are a

description of the statistical design of the survey, guidelines for

judging the precision of the estimates, definitions of terms used in

the survey, and copies of the survey instruments. A complete

description of the plan and operation of the NHAMCS has been

published (5).

Ambulatory medical care is the predominant method for the

provision of health care services in the United States. In 1991,

there were approximately 1.43 billion ambulatory medical care

visits in the United States (6). This care is provided in a wide

variety of settings, and physicians’ office visits account for the

largest proportion. Since 1973, NCHS has collected data on

patient visits to physicians’ office visits through the National

Ambulatory Medical Care Survey (NAMCS). However, visits to

hospital emergency departments and outpatient departments represent the second largest segment of the ambulatory medical care

system and are not included in the NAMCS. The omission of

hospital ambulatory care from the ambulatory medical care

database has left a significant gap in coverage and has limited the

utility of the NAMCS data. The NHAMCS is meant to fill this

data gap and to respond to the increasing demands for more

complete ambulatory medical care data.

The NHAMCS was developed and tested over a 15-year

period that included three major research projects. In 1976, a

study was conducted under contract with the National Opinion

Research Center (NORC) to assess the feasibility of collecting

data from hospital outpatient departments by applying thencurrent NAMCS Patient Record forms and data methodologies

(7). This project demonstrated the feasibility of collecting data

from hospital settings and provided valuable experience in hospital data collection.

A second project was conducted in 1984, again under

contract with NORC, to test several alternative data collection

methodologies in hospital ambulatory care settings (8). Results

from this study included a variety of survey design recommendations: use of a multistage probability design, maintenance of both

a prospective as well as a retrospective method of data collection,

changes in the Patient Record form, and use of personal inductions of hospitals and clinics.

The final research project, conducted in 1989 under contract

with Westat Inc., was a pilot study to develop the national sample

design. This included the determination of the optimum number

and allocation of the sampling units at each stage of sampling, the

stratification variables, and the estimation and variance procedures

(9). Recommendations from this study included the use of two of

the four panels of the National Health Interview Survey (NHIS)

sample of primary sampling units (PSU’s) for the sampling frame;

use of a four-stage design with a nonrotating sample of hospitals;

stratification of hospitals by various indicators and the clinics by

specialty area; and use of a 4-week data collection period.

The NHAMCS thus becomes one of the newest of the

national surveys conducted by the Division of Health Care

Statistics. NCHS has authority under Section 306(b) (1) (F) of the

Public Health Service Act (42 USC 242k) to collect data concerning the public’s use of health care and services. To address the

need for expanded ambulatory medical data as well as the

considerable diversification in the organization, financing, and

delivery of ambulatory medical care, NCHS developed a plan to

restructure its surveys of health care providers. Under this plan,

the NAMCS, the National Hospital Discharge Survey (NHDS),

the National Nursing Home Survey (NNHS), and the National

Master Facility Inventory (NMFI) (all conducted within the

Division of Health Care Statistics) have been modified and

expanded into an integrated National Health Care Survey (NHCS).

One objective of the NHCS is to expand coverage into health

care providers and settings not previously surveyed, including

hospital emergency and outpatient departments, ambulatory surgery centers, home health agencies, and hospices. The NHAMCS

represents an important step in the expansion of the National

Health Care Survey.

1
Source and limitations

of the data

The 1992 NHAMCS consisted of a national probability

sample of visits to the emergency and outpatient departments

of noninstitutional general and short-stay hospitals, excluding

Federal, military, and Veterans Administration hospitals, located

in the 50 States and the District of Columbia. The NHAMCS

was designed to provide estimates based on the following

priority of survey objectives: United States, region, emergency

and outpatient departments, and type of ownership. The

NHAMCS used a four-stage probability design with samples

of PSU’s, hospitals within PSU’s, clinics within hospitals, and

patient visits within clinics. Within hospital emergency service

areas and outpatient department clinics, patient visits were

systematically selected over a randomly assigned 4-week

reporting period. A visit was defined as a direct personal

exchange between a patient and a physician, or a staff member

acting under a physician’s direction, for the purpose of

seeking care and rendering health services. Visits solely for

administrative purposes, such as paying a bill, and visits in

which no medical care was provided, such as visits to deliver

a specimen, were out of scope. A more detailed description of

the 1992 NHAMCS sample design and data collection procedures is in appendix I. Definitions of terms used in the survey

are given in appendix II, and copies of the survey forms and

instruments are shown in appendix III.

Of the 524 hospitals in the 1992 NHAMCS sample, 474

were in-scope, or eligible to participate in the survey. Ninetytwo percent of the eligible facilities participated in the

NHAMCS by completing Patient Record forms.

Based on an induction interview, 437 of the sample

hospitals had emergency departments. Hospital staff were

asked to complete Patient Record forms for a systematic

random sample of patient visits occurring during a randomly

assigned 4-week period. The number of Patient Record forms

completed for ED’s was 36,271.

Because the estimates presented in this report are based

on a sample of hospital emergency department visits rather

than on the entire universe of such visits, they are subject to

sampling variability. For this reason, the reader is urged to

consult the technical notes in appendix I on reliability of the

estimates and an explanation of sampling errors. Estimates

with a relative standard error greater than 30 percent are

considered to be unreliable according to the standards of the

National Center for Health Statistics, and are shown in the text

with an asterisk next to them. Figures marked with an asterisk

may be combined with related estimates to possibly produce a

more reliable overall estimate for a broader category.

It is important to keep in mind that the NHAMCS is an

event-based survey, providing data on visits to hospital emergency and outpatient departments, rather than a person-based

survey. Therefore, estimates of incidence and prevalence cannot be produced using NHAMCS data.

While a number of edit procedures ensure the completeness and consistency of data collected on the Patient Record

form (see appendix I), no validation studies have been undertaken to assess the degree of correspondence between responses

on the Patient Record form and source data from hospital

medical records. A small scale followup of survey respondents

was undertaken in 1994 to answer questions about data

quality, participant reaction to the survey, and suggestions for

redesign of the Patient Record forms. This study suggested

that there was some inconsistency in how respondents were

interpreting survey items on urgency of visits and whether the

visit was alcohol- or drug-related. (See ‘‘Alcohol and drugrelated visits.’’) Also, some respondents were not marking

multiple expected sources of payment where appropriate and

did not know whether the patient made a copayment. The

majority of respondents, however, reported little or no difficulty in understanding and completing NHAMCS Patient

Record forms.

It should also be noted that, while data on patient’s race

and ethnicity are collected on the Patient Record form, hospital staff are not instructed to ask this information of the

patient. Results from the followup study suggested that in the

majority of cases, determinations of race and ethnicity were

based on visual observation by hospital staff, and, less frequently, on patient self-report. Ethnicity data are not included

in this report because of the item’s high nonresponse rate

(15 percent).

The NHAMCS instruments continue to be refined, based

on survey experience, participant feedback, and expert consultation. The Patient Record form was modified slightly for the

1993–94 NHAMCS, and more substantially for 1995–96 with

an expanded section on expected source(s) of payment, injury

status, and diagnostic/screening services ordered or provided

at the visit. Several items were added, including time of the

ED visit and patient’s cigarette-smoking status. Redesign of

the 1997–98 Patient Record form is currently underway. New

items may include method of transport to the ED, level of

patient’s pain upon presentation, and perceived immediacy

with which patients should be seen.

2
Data highlights

+ An estimated 89.8 million visits were made to the emergency departments of non-Federal, general and short-stay

hospitals in the United States in 1992—357.1 visits per

1,000 persons.

+ Persons 75 years of age and over had a higher ED visit

rate than persons in five other age categories—557.6 visits

per 100 persons during 1992.

+ White persons accounted for 78.5 percent of all ED visits,

while black persons and Asians/Pacific Islanders made

19.1 percent and 1.6 percent, respectively. However, the

ED visit rate for black persons was significantly higher

than the rate for white persons overall and for every age

category except 65–74 years and 75 years and over.

+ More than half of all ED visits were illness related, and

more than one-third were injury related. The majority of

ED visits (87.0 percent) were first visits for the presenting

problem.

+ ‘‘Stomach and abdominal pain, cramps, and spasms’’ and

‘‘chest pain and related symptoms’’ were the two most

frequently mentioned reasons for visiting the ED, accounting

for about five million visits each, or 10.7 percent of the total.

+ The most frequent specific diagnosis at ED visits was

‘‘suppurative and unspecified otitis media,’’ accounting for

3.2 million visits, or 3.5 percent of the total. The majority

of ED visits received principal diagnoses within the broad

categories of injury and poisoning (32.7 percent), diseases

of the respiratory system (12.1 percent), and ‘‘symptoms,

signs, and ill-defined conditions’’ (11.7 percent).

+ Accidental falls accounted for the largest share of injuryrelated ED visits (22.7 percent), followed by motor vehicle

accidents (12.2 percent). Homicide and other injury purposely inflicted by others accounted for 4.6 percent of

injury-related ED visits overall, but 10.9 percent of injuryrelated visits by black persons.

+ 2.5 million ED visits were alcohol related (2.7 percent),

and 1 million (1.1 percent) were drug related.

+ 87.9 percent of ED visits included one or more diagnostic

or screening service, with blood pressure check being

reported most frequently, at 73.7 percent of visits.

+ Procedures were performed at 42.3 percent of ED visits. The

administration of intravenous fluids (14.9 percent) and wound

care (12.9 percent) were reported most frequently.

+ Expected sources of payment at ED visits were most often

private/commercial insurance (36.0 percent), Medicaid

(22.7 percent), and Medicare (15.1 percent).

+ Health care providers seen at ED visits were most commonly registered nurses (83.1 percent) and staff physicians

(82.5 percent).

+ 13.5 percent of ED visits resulted in admission to the

hospital; the most frequent disposition was referral to

another physician or clinic (37.0 percent). One-quarter

(25.0 percent) were instructed to return to the emergency

room as needed for followup care.

+ The likelihood of hospital admission increased with patient’s

age. About one-fifth (21.1 percent) of ED visits by persons

45–64 years of age resulted in hospital admission compared with almost half (45.9 percent) of the visits by

persons 75 years and over.

3
Visits to hospital emergency

departments

In this section, visits to hospital emergency departments

(ED’s) are discussed in terms of patient characteristics and

visit characteristics. These include age, sex, and race of

patients; geographic region of the visit; major reason for the

visit as reported by hospital staff (illness, injury, or other);

principal reason for visit as expressed by the patient; injuryrelated visits; alcohol- and drug-related visits; diagnostic and

screening services ordered or provided; principal diagnosis

rendered by hospital staff; procedures performed; medication

therapy; providers seen; expected sources of payment; visit

disposition; facility ownership status; and urgency of visit.

References are made throughout the text to the detailed tables

found at the back of the report. Some overlap of topics is

unavoidable, and cross-references are made to related topics in

the report.

Age, sex, and race of patients

During the 12-month period from January–December

1992, an estimated 89.8 million visits were made to ED’s of

non-Federal, general or short-stay hospitals in the United

States, or 357.1 visits per 1,000 persons. Persons 25–44 years

of age accounted for nearly one-third (30.3 percent) of all ED

visits, while those under 15 years made one-quarter of the

visits (25.1). Persons 75 years of age and over had a higher

ED visit rate (557.6 visits per 1,000 persons) than persons in

the other five age categories. Females made 51.9 percent of all

ED visits, but there was no significant difference in total visit

rates by sex. ED visits by patient’s age, sex, and race are

shown in table 1.

White persons made 78.5 percent of all ED visits, with

black persons and Asians/Pacific Islanders accounting for

19.1 percent and 1.6 percent, respectively. The visit rate for

black persons was significantly higher than for white persons

overall and in each age category except 65–74 years and 75

years and over (figure 1).

Geographic region of visit

ED visits by geographic region are shown in table 2. The

largest proportion of ED visits occurred in the South (32.9 percent), but that region’s visit rate (349.8 visits per 1,000

Figure 1. Annual rate of emergency department visits by patient’s age and race: United States, 1992

NOTES: Visit rate is based on U.S. Bureau of the Census estimates of the civilian noninstitutionalized population of the United States as of July 1, 1992.

Estimates for other races are not shown separately because of statistical unreliability.

Under

15 years

15 24

years

25 44

years

45 64

years

65 74

years

75 years

and over

Patient’s age

0

100

200

300

400

500

600

700

Number of visits per 1,000 persons

All races

White

Black

Patient’s race

4
persons per year) was not significantly different than the

Northeast or Midwest. The Midwest had a higher ED visit rate

(419.6 visits per 1,000 persons) than the West (315.8 visits per

1,000 persons) did. The visit rate for black persons in the

Midwest was markedly higher (759.9 visits per 1,000 persons)

than visit rates for black persons in the other three regions, but

this finding should be treated with caution. The difference may

be due to the inclusion in the 1992 sample of a large number

of hospitals in Illinois and Ohio that reported high concentrations of black patients.

Major reason for visit as reported by

hospital staff

While the majority of ED visits (56.7 percent) were

illness related, more than one-third (37.8 percent) were injury

related. There were 202.6 illness visits and 135.0 injury visits

per 1,000 persons, respectively. For this report, visits were

defined as injury related if ‘‘injury, first visit’’ or ‘‘injury,

followup visit’’ was reported in item 9 of the Patient Record

form, or if a cause of injury was reported in item 10 (table A).

Illness-related visits were defined as those for which ‘‘illness,

first visit’’ or ‘‘illness, followup visit’’ was reported in item 9

of the Patient Record form and which did not have a cause of

injury specified in item 10.

As shown in figure 2, the rate of illness-related ED visits

was higher than injury-related visits for each age group except

15–24 years, and the gap between the illness and injury rates

widens with patient’s age. Persons 75 years and over had the

highest rate of illness-related ED visits (394.7 per 1,000

persons).

Data on major reason for visit according to patient’s age,

sex, and race are shown in table 3. Visits by black persons

were more likely to be illness-related (349.1 visits per 1,000

black persons) than were visits by white persons (185.2 visits

per 1,000 white persons). However, the rate of injury-related

visits was not significantly different for white persons compared with black persons (figure 3). Eighty-seven percent of

all ED visits were first visits for the presenting problem.

Table A. Number, percent distribution, and annual rate of

emergency department visits by whether visit was injury related:

United States, 1992

Was visit injury related?

Number of

visits in

thousands

Percent

distribution

Number of

visits per 1,000

persons per

year1

All visits ................ 89,796 100.0 357.1

All injury-related visits2 ....... 33,950 37.8 135.0

Reported in item 9 as

injury related3 .......... 31,566 35.2 125.5

Cause of injury reported in

item 104 .............. 2,383 2.7 9.5

All noninjury-related visits ..... 55,846 62.2 222.1

Illness related5 .......... 50,931 56.7 202.6

Other reason6 ........... 4,915 5.5 19.5

1Based on U.S. Bureau of the Census estimates of the civilian noninstitutionalized population

of the United States as of July 1, 1992.

2Includes visits reported by hospital staff as injury related in item 9 of the Patient Record

form as well as visits that had a stated cause of injury in item 10, regardless of the response

to item 9.

3Major reasons reported by hospital staff in item 9 were illness, injury, and other (for

example, preadmission examination).

4Includes visits that were not reported as injury related in item 9, but that had a stated cause

of injury reported in item 10.

5Includes visits that were reported as illness related in item 9 and that did not have a stated

cause of injury in item 10.

6Other reasons include preadmission examination.

NOTE: Numbers may not add to totals because of rounding.

Figure 2. Annual rate of emergency department visits by patient’s age and major reason for visit: United States, 1992

NOTES: Visit rate is based on U.S. Bureau of the Census estimates of the civilian noninstitutionalized population of the United States as of July 1,1992.

Major reason for visit is based on responses to items 9 and 10 on the Patient Record form.

Under

15 years

75 years

and over

Patient’s age

0

100

200

300

400

500

Number of visits per 1,000 persons

Illness

Injury

Other

15 24

years

25 44

years

45 64

years

65 74

years

5
Injury-related ED visits are discussed in greater detail in a

later section of this report.

Patient’s principal reason for visit

In item 11 of the Patient Record form, hospital staff were

asked to record the patient’s (or patient’s spokesperson’s)

‘‘complaint(s), symptom(s), or other reason(s) for this visit’’

using the patient’s own words, if possible. Up to three reasons

for visit were coded and classified according to A Reason for

Visit Classification for Ambulatory Care (RVC) (10). The

principal reason is the problem, complaint, or reason listed in

item 11a of the ED Patient Record form.

Table 4 shows ED visits by the patient’s principal reason

for visit. The RVC is divided into eight modules or groups of

reasons: symptom; disease; diagnostic/screening and preventive; treatment; injuries and adverse effects; test results; administrative; and other, which includes problems and complaints

not classified elsewhere, illegible entries, blanks, and entries

of ‘‘none.’’ The symptom module accounted for nearly threequarters of all ED visits (71.3 percent), with general symptoms

accounting for 15.2 percent of visits and symptoms referable

to the musculoskeletal system accounting for 14.8 percent

(figure 4).

The injuries and adverse effects module accounted for

one-fifth of ED visits overall (20.3 percent) and one-quarter of

ED visits made by males (24.9 percent). One might have

expected this module to account for a higher proportion of ED

visits because more than one-third of all visits were injury

related. However, the patient’s reason for visit was expressed

in symptomatic terms rather than injury terms at a substantial

proportion of these visits.

Table 5 shows the 60 principal reasons for ED visits most

often mentioned by patients. These reasons accounted for

three-quarters (75.0 percent) of all ED visits. ‘‘Stomach and

abdominal pain, cramps and spasms’’ was mentioned most

frequently (5.5 percent of the total), followed by chest pain

(5.2 percent), and fever (4.1 percent). ‘‘Lacerations and cuts of

upper extremity’’ was the most frequently mentioned reason

for visit in the injury module, accounting for 2.6 percent of ED

visits overall.

The RVC differentiates between shortness of breath (6th

in the overall ranking) and labored or difficult breathing (17th

in the ranking). It is interesting to note that if estimates for

these two reasons were combined, the total would be 3.3

million ED visits, and shortness of breath/labored breathing

would appear as the fourth most frequent reason for visiting

the ED.

The 10 principal reasons for visit most frequently mentioned by patients according to patient’s age, sex, and race are

shown in table 6. The most frequent reason for visits by

persons under age 15 was fever, accounting for 50.5 visits per

1,000 persons. ‘‘Stomach and abdominal pain, cramps and

spasms’’ was the most frequent reason given by persons 15–24

years (35.5 visits per 1,000) and 25–44 years (21.6 visits per

Figure 3. Annual rate of emergency department visits by

patient’s race and major reason for visit: United States, 1992

NOTES: Visit rate is based on U.S. Bureau of the Census estimates of

the civilian noninstitutionalized population of the United States as of

July 1, 1992.

Major reason for visit is based on responses to items 9 and 10 on the

Patient Record form.

All reasons Illness Injury Other

Major reason for visit

0

100

200

300

400

500

600

Number of visits per 1,000 persons

All races White Black

Figure 4. Percent distribution of emergency department visits by patient’s principal reason for visit: United States, 1992

NOTE: Based on Reflects the reason for visit given by the patient.

General

symptoms

Musculoskeletal Digestive

symptoms

Respiratory

symptoms

Other

symptoms

Injuries and Other reasons

Patient’s principal reason for visit

0

5

10

15

20

25

Percent distribution

symptoms

adverse

effects

A Reason for Visit Classification for Ambulatory Care (10).

6
1,000). Chest pain and related symptoms led the list for visits

by age groups 45–64, 65–74 years, and 75 years and over,

accounting for as many as 62.1 visits per 1,000 persons 75

years and over. Seven of the top 10 reasons for visit were the

same for males and females, and 8 of the top 10 were the same

for white persons and black persons. It should be noted that

estimates that differ in ranked order may not be significantly

different from each other.

Emergency department visits are shown by selected principal reasons for visit according to patient’s age, sex, and race

in table 7. Fever accounted for 12.7 percent of all ED visits by

persons under the age of 15 years, but only 1–2 percent of the

visits for all other age groups. Among persons 45–64 years

and 65 years and over, chest pain accounted for 10–11 percent

of ED visits.

Table 8 shows the percent distribution of ED visits by

patient’s age and sex according to selected principal reasons

for visit. Females made 63.3 percent of all ED visits for

‘‘stomach and abdominal pain, cramps, and spasms,’’ while

males made 71.1 percent of all visits for ‘‘lacerations and cuts

of upper extremity.’’ More than three-quarters (77.5 percent)

of all visits for fever were made by persons under the age of

15. This age group also accounted for more than half (54.9 percent) of the visits for cough. Additional information on a

patient’s reason for visit is contained within the sections on

diagnostic services, diagnosis, and urgency.

Injury-related visits

As previously noted, an ED visit was considered to be

injury related if ‘‘injury, first visit’’ or ‘‘injury, followup’’ was

recorded in item 9 of the Patient Record form, or if a cause of

injury was listed in item 10, regardless of what was recorded

in item 9.

There were 34.0 million injury-related ED visits in 1992,

or 37.8 percent of all ED visits, and the annual rate of

injury-related visits was 135.0 per 1,000 persons. Males had a

significantly higher rate of injury-related visits than females

had. Injury-related visits by age, sex, and race, and geographic

region of the visit are shown in table 9.

Table 10 shows injury-related ED visits by the 20 most

frequent principal reasons for visit as expressed by the patient

according to the patient’s age, sex, and race. ‘‘Lacerations and

cuts of the upper extremity’’ was cited most frequently overall

(6.8 percent of all injury-related ED visits), and for every age

group except those under 15 years. Within that group, ‘‘lacerations and cuts of the facial area’’ accounted for 8.5 percent of

visits.

Table 11 shows the percent distribution of injury-related

ED visits by patient’s age, sex, and race for each of the 20

most frequent principal reasons for visit. Nearly three-quarters

(71.4 percent) of the visits for upper extremity lacerations

were made by males, and about one-third (37.8 percent) were

made by persons 25–44 years of age.

Table 12 presents injury-related ED visits by the 20 most

frequent three-digit principal diagnoses according to a patient’s

age, sex, and race. The principal diagnosis or problem associated with the patient’s most important reason for visit is

recorded in item 12 of the Patient Record form, along with any

other significant current diagnoses. Up to three diagnoses are

coded and classified according to the International Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–

CM) (11).

Overall, ‘‘other open wound of head’’ (which excludes

injury to the eye and ear, but includes the scalp, face, nose,

and mouth) was the diagnosis reported most frequently at

injury-related ED visits. It accounted for the largest proportion

of visits (14.2 percent) by those under 15 years, as well as for

those 65 years and over (8.6 percent of visits).

In table 13, the percent distribution of injury-related ED

visits are shown by patient’s age, sex, and race according to

the 20 most frequent three-digit principal diagnoses. About

half (48.2 percent) of the visits with the diagnosis of ‘‘other

open wound of head’’ were made by persons under 15 years of

age and nearly two-thirds (64.9 percent) were made by males.

Up to three external causes of injury were coded and

classified according to the ICD–9–CM (11). External causes of

injury were reported for 84.2 percent of the injury-related

visits. For some visits, place of occurrence was reported as the

first-listed cause of injury. In cases where this occurred, if

there was a valid cause of injury in the second position, the

latter was used in place of the former for the purpose of this

analysis.

Table 14 shows injury-related ED visits by first-listed

cause of injury (classified by ICD–9–CM E-codes) according

to patient’s age, sex, and race. Accidental falls were the

leading cause of injury-related ED visits overall (22.7 percent), and in each age group except 15–24 years. Among

injury visits by that group, motor vehicle accidents accounted

for 17.9 percent of the total.

In table 15, the percent distribution of injury-related ED

visits is shown by patient’s age, sex, and race according to

principal cause of injury. About one-third (32.8 percent) of all

visits precipitated by accidental falls were made by children

under the age of 15 years.

Table 16 displays injury-related visits by the top 10

principal causes of injury, according to patient’s age, sex, and

race. Although accidental falls ranked as the top cause of

injury-related ED visits among all age groups but one, the rate

of visits varied widely and was highest among persons under

15 years (44.8 visits per 1,000 in 1992) and among those 65

years and over (48.6 visits per 1,000).

Accidents caused by cutting or piercing instruments or

objects and striking against or being struck accidentally by

objects or persons were the third and fourth leading causes of

injury-related ED visits for both males and females, but the

rates stood in sharp contrast by sex. Together, these two causes

accounted for 16.2 visits per 1,000 females in 1992, compared

with 32.7 visits per 1,000 males. ‘‘Homicide and other injury

purposely inflicted by others’’ was the sixth leading cause

of injury visits overall. However, it was the third leading

cause for black persons, accounting for 17.3 ED visits per

1,000 persons compared with 4.6 visits per 1,000 white

persons (figure 5). Black persons were, therefore, almost

four times more likely than white persons to make an ED

visit for injuries related to intentional violence by others.

7
Additional data on injury-related visits to hospital ED’s

have been published (3).

Alcohol- and drug-related visits

An estimated 4.1 million alcohol- and/or drug-related

visits were made to hospital ED’s in 1992 (table B). In

response to a direct question on the survey form, hospital staff

reported 2.5 million alcohol-related ED visits, 1.0 million

drug-related visits, and 327,000 visits that were listed as both

alcohol and drug related. An additional 340,000 visits, while

not recorded as alcohol or drug related in item 14 of the

Patient Record form, included principal diagnoses considered

to be alcohol or drug related and have been included in the

total count. A report containing additional information on

alcohol- and drug- related ED visits, as well as a list of the

ICD–9–CM codes used in determining whether a visit was

alcohol or drug related, has been published (4). It should be

noted that NHAMCS estimates of ED visits that are alcohol

and/or drug related may actually understate the actual number

of such visits. This is because the information used to identify

alcohol- and drug- related visits may not always be included

on the patient’s medical record.

Males had a rate of 20.4 alcohol- and/or drug-related ED

visits per 1,000, compared with 12.6 visits per 1,000 females.

Corresponding rates for white persons and black persons were

14.6 and 29.7 visits per 1,000, respectively. Black males had

the highest risk of making an alcohol- or drug-related ED visit

compared with other sex and race groups (4). Alcohol- and

drug-related ED visits are shown by patient’s age, sex, and

race in table 17.

Diagnostic and screening services

Statistics on various diagnostic and screening services

ordered or provided by hospital staff during the ED visit are

shown by patient’s age, sex, and race in table 18. About 9 of

every 10 ED visits included one or more diagnostic or

screening services (87.9 percent). Blood pressure check was

mentioned most frequently, occurring at about three-quarters

of the visits (73.7 percent). Other frequently mentioned services included ‘‘other’’ blood test (28.7 percent), chest x ray

Figure 5. Annual rate of injury-related emergency department visits by the most frequent principal causes of injury and patient’s race:

United States, 1992

NOTE: Rates are based on U.S. Bureau of the Census estimates of the civilian noninstitutionalized population of the United States as of July 1, 1992.

1Based on the

Accidental fall Motor vehicle

accident

Cutting or

piercing objects

Striking against Overexertion

Principal cause of injury

0

5

10

15

20

25

30

35

Visits per 1,000 persons

White Black

Homicide and

injury purposely

inflicted by others

or struck

accidentally

1

International Classification of Diseases, 9th Revision, Clinical Modification (11).

Table B. Number, percent distribution, and annual rate of

emergency department visits by whether visit was alcohol and/or

drug related: United States, 1992

Visit characteristic

Number of

visits in

thousands

Percent

distribution

Number of

visits per

1,000 persons

per year1

All visits ................ 89,796 100.0 357.1

All alcohol- and/or drug-related

visits ................. 4,122 4.6 16.4

Alcohol related .......... 2,459 2.7 9.8

Drug related . . . . . . . . . . . . 996 1.1 4.0

Both alcohol and drug

related . . . . . . . . . . . . . . . 327 0.4 1.3

Alcohol- and/or drug-related

diagnosis2 . . . . . . . . . . . . 340 0.4 1.4

All other visits ............ 85,674 95.4 340.7

1Based on U.S. Bureau of the Census estimates of the civilian noninstitutionalized population

of the United States as of July 1, 1992.

2Includes visits that were not listed as alcohol or drug related in item 14 of the Patient Record

form, but had alcohol and/or drug-related diagnoses as defined in a previous report (4).

NOTE: Numbers may not add to totals because of rounding.

8
(16.8 percent), urinalysis (15.2 percent), and extremity x ray

(15.1 percent). Diagnostic services were reported at 71.8 percent of visits made by children under age 15, compared with

96.9 percent of visits made by persons 75 years and over.

Figure 6 shows diagnostic services ordered or provided at

illness-related and injury-related ED visits.

In table 19, four diagnostic services—chest x ray, extremity x ray, electrocardiogram, and mental status exam—are

shown according to ranked principal reasons for visit. Of the

15.1 million ED visits at which chest x rays were ordered or

performed, one-fifth (20.7 percent) occurred at visits for chest

pain. Additionally, chest x rays were reported at two-thirds

(67.5 percent) of visits for chest pain overall.

Electrocardiograms (EKG’s) were reported at threequarters (75.0 percent) of visits for chest pain, and one-half

(51.8 percent) of visits for shortness of breath.

Principal diagnosis

As mentioned earlier, the principal diagnosis or problem

associated with the patient’s most important reason for the

visit is recorded in item 12 of the Patient Record form, along

with any other significant current diagnoses. Up to three

diagnoses are coded and classified according to the ICD–

9–CM (11). Data on principal diagnosis are shown in tables 20–

25, using the major disease categories specified by the ICD–

9–CM as well as selected three-digit diagnoses. Among the

broad diagnostic categories, injury and poisoning accounted

for 32.7 percent of all ED visits, and diseases of the respiratory system accounted for 12.1 percent (figure 7).

The 60 most frequently rendered principal diagnoses at ED

visits are shown in table 20. These are categorized at the threedigit coding level of the ICD–9–CM and account for 63.4 percent

of ED visits. The most commonly recorded diagnosis was

suppurative and unspecified otitis media, occurring at 3.5 percent

of all visits. Table 21 displays the 10 principal diagnoses most

frequently rendered by patient’s age, sex, and race.

Table 22 shows ED visits by selected principal diagnoses

according to patient’s age, sex, and race. Injury and poisoning

diagnoses accounted for one-third (33.8 percent) of visits by

persons under 15 years, and accounted for the largest share of

visits in each age group.

Table 23 shows the percent distribution of ED visits by

patient’s age, sex, and race according to selected principal

diagnoses. Of visits with a principal diagnosis of suppurative

and unspecified otitis media, 87.7 percent were made by

children under 15 years. This age group also accounted for

nearly two-thirds (64.7 percent) of visits for acute upper

respiratory tract infections and more than one-third (39.4 percent) of visits with a diagnosis of asthma.

In table 24, ranked diagnoses are presented for each of the

10 top reasons given by patients for visiting the ED. Diagnostic services ordered or provided at visits for selected principal

diagnoses are shown in table 25.

Procedures

Procedures were performed at 42.3 percent of ED visits

(table 26). The most frequently mentioned procedure was

the administration of intravenous fluids (14.4 percent of the

total). The procedure was performed at 31.9 percent of

visits by persons 65–74 years, and at 37.6 percent of visits

by persons 75 years and over. Wound care (12.9 percent of

CT is computerized tomography and MRI is magnetic resonance imaging.

None

Blood pressure

check

Urinalysis

Other blood test

Electrocardiogram

Mental status

exam

Chest x ray

Extremity x ray

CT scan/MRI

Other diagnostic

imaging

Diagnostic or screening service

80 60 40 20 0

Percent of illness

visits

0 20 40 60 80

Percent of injury

visits

NOTE: More than one service may be reported per visit.

1

1

Figure 6. Percent of emergency department visits by major

reason for visit, according to selected diagnostic and screening

services ordered or provided: United States, 1992

Based on the 

32.7

12.1

11.7

6.7

6.1

4.3

4.2

4.2

3.5

3

2.7

8.8

Injury and

poisoning

Respiratory

diseases

Symptoms, signs,

and ill defined

conditions

Nervous system and

sense organs diseases

Digestive

diseases

Circulatory

diseases

Musculoskeletal

and connective

tissue diseases

Genitourinary

diseases

Infectious and

parasitic diseases

Skin and subcutaneous

tissue diseases

Mental disorders

All other

diagnoses

Principal diagnosis (broad category)

0 10 20 30 40

Percent distribution of visits

1

1

International Classification of Diseases, 9th Revision, Clinical

Modification (11).

Figure 7. Percent distribution of emergency department visits by

principal diagnosis: United States, 1992

9
all ED visits) and orthopedic care (7.9 percent) were also

prominent. Wound care was performed at a higher percent

of visits by males (17.0 percent) compared with visits by

females (9.0 percent).

Medication therapy

About two-thirds of the total (69.1 percent), or 62.1

million ED visits, included a new or continued medication

ordered or provided by hospital staff during 1992. Visits with

one or more drug mentions are termed ‘‘drug visits’’ in the

NHAMCS. As many as five medications or drug mentions

could be reported per ED visit, resulting in a total of 117.4

million drug mentions. This yields an average of about 1.9

drugs per drug visit, or 1.3 drugs per ED visit overall.

Table 27 shows data on medication therapy at ED visits

by age, sex, and race of the patient. Drug mentions at ED

visits are displayed by therapeutic class in tables 28–30. This

classification is based on the therapeutic categories used in the

National Drug Code Directory, 1985 edition (12). The most

frequently mentioned therapeutic class was drugs used for

relief of pain (29.8 percent), followed by antimicrobial agents

(16.7 percent), and respiratory tract drugs (11.4 percent).

Table C shows the drugs utilized at ED visits by generic

ingredients. Acetaminophen was the most frequently occurring

generic ingredient, occurring in 14.4 percent of drugs mentioned at ED visits. The top 20 drugs by entry name (the actual

entry made by hospital staff on the Patient Record form) are

shown in table D. These 20 accounted for more than one-third

Table C. Number of occurrences and percent of all drug

mentions by the 20 most frequent generic substances in drug

mentions at emergency department visits: United States, 1992

Generic substance

Number of

occurrences in

thousands1

Percent of

all drug

mentions2

All generic substances ......... 140,490 . . .

Acetaminophen ............. 16,898 14.4

Ibuprofen ................. 6,729 5.7

Amoxicillin ................ 5,145 4.4

Codeine .................. 4,067 3.5

Albuterol .................. 3,342 2.8

Promethazine .............. 3,236 2.8

Meperidine ................ 3,040 2.6

Ketorolac tromethamine ........ 2,961 2.5

Hydrocodone ............... 2,353 2.0

Erythromycin ............... 2,093 1.8

Lidocaine ................. 1,918 1.6

Diphenhydramine ............ 1,873 1.6

Hydroxyzine ............... 1,840 1.6

Nitroglycerin ............... 1,675 1.4

Oxygen .................. 1,639 1.4

Tetanus toxoid .............. 1,630 1.4

Magnesium antacids .......... 1,589 1.4

Cephalexin ................ 1,588 1.4

Propoxyphene .............. 1,453 1.2

Polymixin B ................ 1,326 1.1

. . . Category not applicable.

1Frequency of mention combines single-ingredient agents with mentions of the agent as an

ingredient in a combination drug.

2Based on an estimated 117,419,000 drug mentions at visits to emergency departments in

1992.

Table D. Number, percent distribution, and therapeutic classification of the 20 drugs most often mentioned at emergency department

visits, by entry name of drug: United States, 1992

Entry name of drug1

Number of

drug mentions

in thousands

Percent

distribution

Therapeutic

classification2

All drug mentions ........................ 117,419 100.0 . . .

Tylenol ............................... 8,334 7.1 Drugs used for relief of pain

Motrin ............................... 3,574 3.0 Drugs used for relief of pain

Amoxicillin ............................ 3,210 2.7 Antimicrobial agents

Toradol .............................. 2,961 2.5 Drugs used for relief of pain

Phenergan ............................ 2,873 2.4 Respiratory tract drugs

Demerol .............................. 2,825 2.4 Drugs used for relief of pain

Tylenol No. 3 ........................... 2,476 2.1 Drugs used for relief of pain

Benadryl .............................. 1,819 1.5 Respiratory tract drugs

Oxygen .............................. 1,639 1.4 Anesthetic drugs

Vistaril ............................... 1,619 1.4 Psychopharmacologic drugs

Keflex ............................... 1,399 1.2 Antimicrobial agents

Vicodin .............................. 1,375 1.2 Drugs used for relief of pain

Advil ................................ 1,349 1.1 Drugs used for relief of pain

Proventil .............................. 1,325 1.1 Respiratory tract drugs

Darvocet-N ............................ 1,322 1.1 Drugs used for relief of pain

Diphtheria Tetanus Toxoids .................. 1,291 1.1 Immunologic agents

Amoxil ............................... 1,255 1.1 Antimicrobial agents

Lasix ................................ 1,204 1.0 Cardiovascular-renal drugs

Rocephin ............................. 1,133 1.0 Antimicrobial agents

Ibuprofen ............................. 1,088 0.9 Drugs used for relief of pain

All other mentions ........................ 75,568 64.4 . . .

. . . Category not applicable.

1The entry made by the hospital staff on the prescription or other medical records. This may be a trade name, generic name, or desired therapeutic effect.

2Based on the National Drug Code Directory, 1985 edition (12). In cases where a drug had more than one therapeutic use, it was listed under the NDC classification that occurred with the greatest

frequency.

NOTE: Numbers may not add to totals because of rounding.

10
of all ED drug mentions (35.6 percent), and nearly half (9 out

of 20) were agents of pain relief.

Table 31 shows ED visits by medication therapy for

selected principal diagnoses. Medication therapy was ordered

or provided at 93.8 percent of visits at which otitis media was

the principal diagnosis.

Providers seen

About 8 of 10 ED visits were attended by a registered

nurse (83.1 percent). In addition, staff physicians saw patients

at 82.5 percent of ED visits. Data on providers seen at ED

visits are shown by age, sex, and race in table 32, and by

major reason for visit in figure 8.

Interestingly, there were an estimated 3.2 million ED

visits not attended by any type of physician. Providers seen at

these visits most often included registered nurses (87.1 percent), physician assistants (20.5 percent), and nurse practitioners (17.5 percent). These visits were more likely to be

followup visits than were visits attended by a physician, and

were more likely to be made for diagnostic or treatment

reasons. About 13 percent included the disposition ‘‘Left against

medical advice’’ compared with only 1 percent of ED visits in

general (data not shown).

Expected source of payment

Expected sources of payment at ED visits were most often

‘‘private/commercial insurance’’ (36.0 percent), Medicaid

(22.7 percent), and Medicare (15.1 percent). ‘‘Patient-paid’’

and ‘‘HMO/other prepaid plan’’ were mentioned at 13.8 percent and 7.3 percent of ED visits, respectively. Hospital staff

were asked to record all expected sources of payment, so that

more than one source could be reported per visit. The patientpaid category includes the patient’s contribution toward ‘‘copayments’’ and ‘‘deductibles.’’ Data on expected sources of

payment are shown by patient’s age, sex, and race in table 33.

Four of every 10 ED visits by children under 15 years

included Medicaid as an expected source of payment.

Visits by expected sources of payment according to major

reason for visit are shown in figure 9. ‘‘Private/commercial

insurance’’ was the expected pay source at four-tenths (41.4 percent) of injury visits and one-third (33.4 percent) of illness

visits. Medicaid was expected to pay for more than onequarter (27.5 percent) of illness visits compared with 14.3 percent of injury visits.

Visit disposition

More than one-third of ED visits resulted in a referral to

another physician or clinic (37.0 percent). While 13.5 percent

of all ED visits resulted in admission to the hospital, this was

more likely for illness visits (18.2 percent) than injury visits

(5.4 percent) (figure 10). Data on disposition of visit are

shown by patient’s age, sex, and race in table 34.

Facility characteristics

About two-thirds (65.8 percent) of ED visits occurred in

voluntary, nonprofit hospitals. One-fifth (21.1 percent) occurred

in proprietary facilities, and 13.1 percent were made to nonFederal government hospitals. The rate of visits to each of

these facility types was 234.9, 46.8, and 75.5 visits per 1,000

NOTE: More than one provider may be reported per visit.

Registered

nurse

Staff

physician

Resident/

intern

Other

physician

Nurse’s aide

Licensed

practical nurse

Nurse

practitioner

Physician

assistant

Providers seen

100 80 60 40 20 0

Percent of illness

visits

0 20 40 60 80 100

Percent of injury

visits

Figure 8. Percent of emergency department visits by major

reason for visit, according to providers seen: United States, 1992

NOTE: More than one expected source of payment may be reported per visit.

Private/

commercial

insurance

Medicaid

Medicare

Patient paid

HMO/other

prepaid 

Other

government

Other

Expected source of payment

50 40 30 20 10 0

Percent of illness

visits

0 10 20 30 40 50

Percent of injury

visits

HMO is health maintenance organization. 1

1

Figure 9. Percent of emergency department visits by major

reason for visit, according to expected source of payment:

United States, 1992

11
persons, respectively. Table 35 shows visit data by facility

ownership according to metropolitan or nonmetropolitan location and patient’s race.

Overall, black persons visited ED’s at a rate of 592.0

visits per 1,000 in metropolitan areas compared with 283.9

visits per 1,000 in nonmetropolitan areas. In contrast, white

persons made 331.5 visits per 1,000 persons in metropolitan

areas and 353.0 visits per 1,000 in nonmetropolitan areas

(figure 11). Black persons made 134.9 visits per 1,000 to

non-Federal government facilities in metropolitan areas compared with only 30.6 visits per 1,000 white persons.

Data on ED visits for each of the three types of facility are

presented by expected source(s) of payment and by disposition

of visit in tables 36 and 37.

Urgency of visit

Much recent literature has focused on the increasing use

of hospital emergency departments for medical conditions

deemed to be nonurgent in nature (13–21). According to one

study, ‘‘the emergency department has become part primary

care physician and part social worker to many Americans’’ (22). But definitions of urgent or emergent care may

vary. According to the American College of Emergency Physicians (ACEP),

Emergency services are those health care services provided in a hospital emergency facility after the sudden

onset of a medical condition that manifests itself by

symptoms of sufficient severity, including severe pain,

that the absence of immediate medical attention could

reasonably be expected by a prudent layperson, who

possesses an average knowledge of health and medicine,

to result in 1) placing the patient’s health in serious

jeopardy; 2) serious impairment to bodily functions; or 3)

serious dysfunction of any bodily part or organ.

The emphasis above is on a prospective determination of

the need for emergency services, rather than on a retrospective

assessment by hospital staff based upon diagnosis of the

patient’s presenting problem.

The NHAMCS included an item on urgency to better

understand the continuum of care provided by hospital ED’s.

For the survey, urgent visits were defined in the instructions

given to sample hospitals as those meeting the following

conditions: ‘‘Patient requires immediate attention for acute

illness or injury that threatens life or function. Delay would be

harmful to the patient.’’ Nonurgent visits were defined as those

in which ‘‘patient does not require attention immediately or

within a few hours.’’

The definition of urgency used in the NHAMCS does not

directly address visits for symptoms that would cause a

‘‘prudent layperson’’ to seek emergency care, but for which it

was later determined that emergency care was not necessary.

Such visits would be considered urgent based on the definition

used by the American College of Emergency Physicians, but

would not be so categorized using a literal interpretation of the

NHAMCS definition. An informal followup of 1994 NHAMCS

respondents indicated that many ED’s were basing their

determination of urgency on the patient’s symptoms, while

other ED’s based them on the physician’s diagnosis or the

treatment provided. Despite the uncertainties related to the

manner in which these data were collected, they are useful for

examining the complex issues surrounding urgency of care.

NOTES: MD is medical doctor; ED is emergency department; and AMA

is against medical advice.

More than one disposition may be reported per visit. 

Dead on arrival/died in ED (not shown) accounted for less than 1 percent of

visits.

Refer to other

physician/clinic

Return to ED

as needed

Return to

referring MD

Admit to hospital

No follow up

planned

Return to ED,

appointment

Transfer to other

facility

Left AMA

Other

Disposition

50 40 30 20 10 0

Percent of illness

visits

0 10 20 30 40 50

Percent of injury

visits

Figure 10. Percent of emergency department visits by major

reason for visit, according to disposition of visit: United States,

1992

NOTES: Rates are based on U.S. Bureau of the Census estimates

of the civilian noninstitutionalized population of the United States

as of July 1, 1992.

"All races" includes races other than white and black.

All races White Black

Patient’s race

0

100

200

300

400

500

600

700

Number of visits per 1,000 persons

Metropolitan area Nonmetropolitan area

1

1

Figure 11. Annual rate of emergency department visits by

patient’s race, according to location of hospital: United States,

1992

12
There are many other factors influencing one’s decision to

seek treatment at an ED. These include the lack of a regular

source of medical care, lack of health insurance, lack of

transportation, need for after-hours care, exposure to violence,

lack of education, dependency on others, lack of a telephone,

and other barriers to care (23). It is important to acknowledge

this continuing debate concerning the relationship between

urgency of visit and appropriateness of ED utilization, and to

avoid equating urgent visits as defined in the NHAMCS with

appropriate visits to hospital ED’s. A comprehensive picture of

urgency and appropriateness must take into account other

factors such as the patient’s subjective reasons for visiting the

ED, nature and severity of the patient’s symptoms, and issues

of access to and availability of alternate source of outpatient

care. Analyses are currently being conducted to better understand the urgency data collected in the NHAMCS and to

modify how the data are collected in future surveys. Additional data on urgency using NHAMCS data have been

published (25,26).

Based on the NHAMCS definition of urgency, the majority (55.4 percent) of ED visits were reported to be nonurgent

in nature, and 44.6 percent were urgent/emergent (table 38).

When compared with five other age categories, persons 75

years and over had the highest urgent visit rate (366.3 visits

per 1,000 persons). Persons 15–24 years of age had a higher

rate of nonurgent visits (263.1 visits per 1,000 persons) than

any other age group except those under 15 years of age. There

was no significant difference between urgent and nonurgent

visit rates by sex. White persons made 153.2 urgent ED visits

per 1,000 persons during the year compared with 227.5 urgent

visits per 1,000 black persons (figure 12). This underscores the

fact that black persons are at greater risk for emergency

medical problems. In addition, there were 183.2 nonurgent

visits per 1,000 white persons compared with 317.6 nonurgent

visits per 1,000 black persons over the same period.

Data on urgency and major reason for visit as reported by

hospital staff are shown in table 39. Almost half of all

illness-related and injury-related visits were judged urgent

(44.2 percent and 46.2 percent, respectively). As one would

expect, a much smaller proportion of followup visits were

reported to be urgent.

Table 40 shows data on urgency and patient’s principal

reason for visit. Of 23 selected principal reasons for ED visits,

nine were judged to be urgent visits at least half of the time.

These reasons were chest pain; lacerations and cuts of upper

extremity, shortness of breath; vomiting; laceration and cuts of

facial area; labored or difficult breathing; head, neck, and face

injury; asthma; and wheezing. On the other hand, although

reasons such as head cold, throat symptoms, and earache were

reported as nonurgent visits in the majority of cases, as many

as one-fifth to one-quarter were designated as urgent by

hospital staff.

Table 41 displays the 25 most frequently mentioned principal reasons for visit for urgent and nonurgent visits. About

half of the most frequent reasons for urgent visits also appear

on the list of the most frequent reasons for nonurgent visits.

For example, chest pain was the most frequently mentioned

reason for visits that were determined by hospital staff to be

urgent in nature, reported at 8.5 percent of all urgent visits.

However, chest pain was listed as the eighth most frequent

reason for nonurgent visits, accounting for 2.4 percent of that

total.

Table 42 shows the percent distribution of selected ED

visits by urgency according to selected principal diagnoses.

NOTES: Based on U.S. Bureau of the Census estimates of the civilian

noninstitutionalized population of the United States as of July 1, 1992.

Urgent visits are defined as those which require immediate attention.

Under 15

years

15 24

years

25 44

years

45 64

years

65 74

years

75 years

and over

Patient’s age

0

100

200

300

400

Number of visits per 1,000 persons

Patient’s race

White Black

Figure 12. Annual rate of urgent emergency department visits by

patient’s age and race: United States, 1992

Refer to other

physician/clinic

Return to ED

as needed

Return to

referring MD

Admit to hospital

No followup

planned

Return to ED,

appointment

Transfer to other

facility

Other 

Disposition

50 40 30 20 10 0

Percent of urgent

visits

0 10 20 30 40 50

Percent of nonurgent

visits

1

NOTES: More than one disposition may be reported per visit.

ED is emergency department and MD is medical doctor.

 Includes "Left against medical advice" and "dead on arrival/died in

emergency department" (each accounting for 1 percent or less of all

emergency department visits), and "other."

1

Figure 13. Percent of urgent and nonurgent emergency

department visits by disposition of visit: United States, 1992

13
Interestingly, four-fifths of the visits with circulatory disease

diagnoses were reported to be urgent by hospital staff, but as

many as one-fifth were reported to be nonurgent.

Data on ED visits by providers seen, according to urgency

of visit, are shown in table 43. A significantly higher proportion of urgent visits was attended by a staff physician (85.0 percent) compared with nonurgent visits (80.5 percent).

Table 44 shows data on expected sources of payment

according to urgency of visit. About one-fifth (20.4 percent) of

urgent visits listed Medicare as an expected source of payment

compared with only 10 percent of nonurgent visits, which

might be expected considering the high rate of urgent visits

among older persons.

As expected, urgent visits were more likely to result in

admission to the hospital compared with nonurgent visits.

About one-quarter (24.9 percent) of urgent visits resulted in

hospital admission compared with 4.3 percent of nonurgent

visits (figure 13). Furthermore, urgent visits that were illness

related were more likely to result in hospital admission than

urgent visits that were injury related. About one-third (34.1 percent) of urgent illness visits resulted in hospital admission

compared with about one-tenth (11.0 percent) of urgent injury

visits (figure 14).

Measurement of the urgency of hospital ED visits is a

complicated and controversial task. The NHAMCS continues

to refine this measure, based upon current research, ongoing

consultation with health care experts, and experience gained

through conducting the annual survey.

For the 1995 and 1996 NHAMCS, an item was added to

the Patient Record form to collect the time of the ED visit.

Data collected in this item will be used to determine, in part,

how many ‘‘nonurgent’’ visits are the result of a need for

after-hours care by the patient. Proposed changes for the

1997–98 NHAMCS include replacing the current item on

urgency with a four-point time scale indicating the perceived

need for immediacy with which the patient should be seen as

determined at time of triage, and adding a measure of the

severity of the patient’s pain upon presentation to the ED.

Also, a new item on mode of arrival to the ED has been

proposed. It is hoped that the data collected by these items will

provide a better understanding of the complex nature of

hospital ED visits.

Refer to other

physican/clinic

Return to ED

as needed

Return to

referring MD

Admit to hospital

No followup

planned

Return to ED,

appointment

Transfer to other

facility

Other 

Disposition

50 40 30 20 10 0

Percent of urgent

illness visits

0 10 20 30 40 50

Percent of urgent

injury visits

NOTES: More than one disposition may be reported per visit.

ED is emergency department and MD is medical doctor.

 Includes "Left against medical advice" and "dead on arrival/died in

emergency department" (each accounting for 1 percent or less of all

emergency department visits), and "other."

1

1

Figure 14. Percent of urgent illness- and injury-related

emergency department visits by disposition of visit: United

States, 1992

14
References

1. McCaig LF. National Hospital Ambulatory Medical Care Survey: 1992 emergency department summary. Advance data from

vital and health statistics, no. 245. Hyattsville, Maryland.

National Center for Health Statistics. 1994.

2. McCaig LF. National Hospital Ambulatory Medical Care Survey: 1992 outpatient department summary. Advance data from

vital and health statistics, no. 248. Hyattsville, Maryland.

National Center for Health Statistics. 1994.

3. Burt CW. Injury-related visits to hospital emergency departments: United States, 1992. Advance data from vital and health

statistics, no. 261. Hyattsville, Maryland. National Center for

Health Statistics. 1994.

4. Nelson CR, Stussman BJ. Alcohol- and drug-related visits to

hospital emergency departments: 1992 National Hospital Ambulatory Medical Care Survey. Advance data from vital and health

statistics, no. 251. Hyattsville, Maryland. National Center for

Health Statistics. 1994.

5. McCaig LF, McLemore T. Plan and operation of the National

Hospital Ambulatory Medical Care Survey. National Center for

Health Statistics. Vital Health Stat 1(34). 1994.

6. Adams PF, Benson V. Current estimates from the National

Health Interview Survey, 1991. National Center for Health

Statistics. Vital Health Stat 10(184). 1992.

7. Extension of the National Ambulatory Medical Care Survey to

hospital outpatient clinic visits. Contract No. 230-76-0065.

Chicago, Illinois: National Opinion Research Center. 1977.

8. Methodological report on the hospital ambulatory medical care

evaluation study. Contract No. 282-82-2111. Chicago, Illinois:

National Opinion Research Center. 1984.

9. Final report—Survey of hospital emergency and outpatient

departments. Contract No. 20-88-7017. Rockville, Maryland:

Westat. 1990.

10. Schneider D, Appleton L, McLemore T. A reason for visit

classification for ambulatory care. National Center for Health

Statistics. Vital and Health Stat 2(78). 1979.

11. Public Health Service and Health Care Financing Administration. International classification of diseases, 9th revision, clinical modification. Washington: Public Health Service. 1991.

12. Food and Drug Administration. National Drug Code Directory,

1985 Edition. Washington: Public Health Service. 1985.

13. Rask KJ, Williams MV, Parker RM, McNagny SE. Obstacles

predicting lack of a regular provider and delays in seeking care for

patients at an urban public hospital. JAMA. 1994;271:1931–33.

14. Baker DW, Stevens CD, Brook RH. Regular source of ambulatory

care and medical care utilization by patients presenting to a public

hospital emergency department. JAMA. 1994;271:1909–12.

15. Lowe RA, Bindman AB, Ulrick SK, et al. Refusing care to

emergency department patients: Evaluation of published triage

guidelines. Ann Emerg Med 1994;23:286–93.

16. Derlet RW, Kinser D. The emergency department and triage of

nonurgent patients. Ann Emerg Med 1994;23:377–79.

17. Nadel V. Emergency Departments: Unevenly Affected by Growth

and Change in Patient Use. Washington, DC: US General

Accounting Office, Human Resources Division: 1993. Publication GAO/HRD 93–4.

18. Kusserow RP. Use of Emergency Rooms by Medicaid Recipients. Washington, DC: US Dept of Health and Human Services,

Office of the Inspector General; 1992.

19. Guterman JJ, Franaszek JB, Murdy D, Gifford M. The 1980

patient urgency study: further analysis of the data. Ann Emerg

Med December 1985; 14:1191–98.

20. Gifford MJ, Franaszek JB, Gibson G. Emergency physicians’

and patients’ assessments: urgency of need for medical care.

Ann Emerg Med October 1980; 9:502–7.

21. The Medicaid Access Study Group. Access of Medicaid recipients to outpatient care. N Engl J Med 1994;330:1426–30.

22. Grumbach K, Keane D, Bindman A. Primary care and public

emergency department overcrowding. Am J Public Health.

1993; 83:372–78.

23. Kellerman AL. Nonurgent emergency department visits: meeting an unmet need. JAMA. 1994; 271:1953–4.

24. Schappert SM. Race differences in the utilization of hospital

emergency departments: data from the National Hospital Ambulatory Medical Care Survey (NHAMCS), 1992. Statistical Bulletin. 1995; 76(3):2–11.

25. Schappert SM. The urgency of visits to hospital emergency

departments: data from the National Hospital Ambulatory Medical Care Survey (NHAMCS), 1992. Statistical Bulletin. 1995;

76(4): 10–19.

26. Massey JT, Moore TF, Parsons VL, Tadros W. Design and

estimation for the National Health Interview Survey, 1985–94.

National Center for Health Statistics. Vital Health Stat 2(110).

1989.

27. Koch H, Campbell WH. The collection and processing of drug

information: National Ambulatory Medical Care Survey, United

States, 1980. National Center for Health Statistics. Vital Health

Stat 2(90). 1982.

28. Shah BV, Barnwell BG, Hunt PN, La Vange LM. SUDAAN

user’s manual, release 5.50. Research Triangle Park, North

Carolina: Research Triangle Institute. 1991.

29. Hansen MH, Hurwitz WN, Madow WG. Sample survey methods and theory vol 1. New York: John Wiley and Sons. 1953.

30. Cochran WG. Sampling techniques. New York: John Wiley and

Sons. 1953.

15
List of detailed tables

Patient characteristics

1. Number, percent distribution, and annual rate of emergency department visits by patient’s age, sex, and race:

United States, 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

2. Number, percent distribution, and annual rate of emergency department visits by patient’s age, sex, and race,

according to geographic region of visit: United States,

1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Reason for visit

3. Number, percent distribution, and annual rate of emergency department visits by major reason for visit,

according to patient’s age, sex, and race: United States,

1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

4. Number and percent distribution of emergency department

visits by patient’s principal reason for visit, according to

patient’s age, sex, and race: United States, 1992 ...... 21

5. Number, percent distribution, and annual rate of emergency department visits by the 60 principal reasons for

visit most often mentioned by patients: United States,

1992 ...................................... 22

6. Number, percent distribution, and annual rate of emergency department visits by patient’s age, sex, race, and 10

most frequent principal reasons for visit: United States,

1992 ...................................... 23

7. Number and percent distribution of emergency department

visits by selected principal reasons for visit, according to

patient’s age, sex, and race: United States, 1992 ...... 26

8. Number and percent distribution of emergency department

visits by patient’s age, sex, and race, according to selected

principal reasons for visit: United States, 1992 ....... 27

Injury-related visits

9. Number, percent distribution, and annual rate of injuryrelated emergency department visits by patient’s age, sex,

and race, and geographic region of the visit: United States,

1992 ...................................... 28

10. Number and percent distribution of injury-related emergency department visits by the 20 most frequent principal

reasons for visit, according to patient’s age, sex, and race:

United States, 1992 ........................... 29

11. Number and percent distribution of injury-related emergency department visits by patient’s age, sex, and race,

according to the 20 most frequent principal reasons for

visit: United States, 1992 ....................... 30

12. Number and percent distribution of injury-related emergency department visits by the 20 most frequent principal

diagnoses, according to patient’s age, sex, and race:

United States, 1992 ........................... 31

13. Number and percent distribution of injury-related emergency department visits by patient’s age, sex, and race,

according to the 20 most frequent principal diagnoses:

United States, 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

14. Number and percent distribution of injury-related emergency department visits by principal cause of injury,

according to patient’s age, sex, and race: United States,

1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

15. Number and percent distribution of injury-related emergency department visits by patient’s age, sex, and race,

according to principal cause of injury: United States,

1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

16. Number, percent distribution, and annual rate of injuryrelated emergency department visits by patient’s age, sex,

race, and most frequent principal causes of injury: United

States, 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Alcohol- and drug-related visits

17. Number, percent distribution, and annual rate of alcoholand/or drug-related emergency department visits by patient’s

age, sex, and race: United States, 1992 . . . . . . . . . . . . . 39

Diagnostic and screening services

18. Number and percent of emergency department visits by

diagnostic and screening services ordered or provided, and

patient’s age, sex, and race: United States, 1992 . . . . . . 40

19. Number and percent distribution of emergency department

visits by selected diagnostic and screening services ordered

or provided and most frequent principal reasons for visit:

United States, 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Principal diagnosis

20. Number, percent distribution, and annual rate of emergency department visits by the 60 most frequent principal

diagnoses: United States, 1992 . . . . . . . . . . . . . . . . . . . 42

21. Number, percent distribution, and annual rate of emergency department visits by patient’s age, sex, race, and 10

most frequent principal diagnoses: United States, 1992 . 43

22. Number and percent distribution of emergency department

visits by selected principal diagnoses, according to patient’s

age, sex, and race: United States, 1992 ............. 46

23. Number and percent distribution of emergency department

visits by patient’s age, sex, and race, according to selected

principal diagnoses: United States, 1992 ............ 48

24. Number and percent distribution of emergency department

visits by selected principal reasons for visit and most

frequent principal diagnoses: United States, 1992 ...... 49

25. Number and percent of emergency department visits by

diagnostic and screening service ordered or provided and

selected principal diagnoses: United States, 1992 ...... 51

26. Number and percent of emergency department visits by

procedures provided and patient’s age, sex, and race:

United States, 1992 ........................... 52

16
27. Number and percent distribution of emergency department

visits by medication therapy, according to patient’s age,

sex, and race: United States, 1992 . . . . . . . . . . . . . . . . . 53

28. Number and percent distribution of drug mentions at

emergency department visits by therapeutic classification:

United States, 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

29. Number and percent distribution of drug mentions at

emergency department visits by therapeutic classification,

according to patient’s age, sex, and race: United States,

1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

30. Number and percent distribution of drug mentions at

emergency department visits by patient’s age, sex, and

race, according to therapeutic classification of drug: United

States, 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

31. Number and percent distribution of emergency department

visits by medication therapy, according to selected principal diagnoses: United States, 1992 . . . . . . . . . . . . . . . . 57

Other visit characteristics

32. Number and percent of emergency department visits by

providers seen and patient’s age, sex, and race: United

States, 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

33. Number and percent of emergency department visits by

expected source of payment and patient’s age, sex, and

race: United States, 1992 . . . . . . . . . . . . . . . . . . . . . . . 59

34. Number and percent of emergency department visits by

disposition of visit and patient’s age, sex, and race: United

States, 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

Facility characteristics

35. Number and percent distribution of emergency department

visits by facility ownership, according to location and

patient’s race: United States, 1992 . . . . . . . . . . . . . . . . 61

36. Number and percent of emergency department visits by

expected source of payment and facility ownership: United

States, 1992 ................................. 62

37. Number and percent of emergency department visits by

disposition of visit and facility ownership: United States,

1992 ...................................... 63

Urgency of visit

38. Number, percent, and annual rate of emergency department visits by urgency of visit and patient’s age, sex, and

race: United States, 1992 ....................... 64

39. Number, percent distribution, and annual rate of emergency department visits by urgency of visit, according to

major reason for visit: United States, 1992 .......... 65

40. Number and percent distribution of emergency department

visits by urgency of visit, according to selected principal

reasons for visit: United States, 1992 .............. 66

41. Number, percent distribution, and annual rate of emergency department visits by urgency of visit and the 25

principal reasons for visit most often mentioned by patients:

United States, 1992 ........................... 67

42. Number and percent distribution of emergency department

visits by urgency of visit, according to selected principal

diagnoses: United States, 1992 ................... 68

43. Number and percent of emergency department visits by

urgency of visit and providers seen: United States, 1992 69

17
Table 1. Number, percent distribution, and annual rate of emergency department visits by patient’s age, sex, and race:

United States, 1992

Patient characteristic

Number of

visits in

thousands

Percent

distribution

Number of

visits per

1,000 persons

per year1

All visits ................................... 89,796 100.0 357.1

Age

Under 15 years .............................. 22,523 25.1 399.0

15–24 years ................................ 14,848 16.5 431.8

25–44 years ................................ 27,240 30.3 334.9

45–64 years ................................ 12,509 13.9 257.9

65–74 years ................................ 5,806 6.5 314.3

75 years and over ............................. 6,871 7.7 557.6

Sex and age

Female ................................... 46,612 51.9 360.6

Under 15 years ............................. 10,196 11.4 370.1

15–24 years ............................... 8,051 9.0 465.7

25–44 years ............................... 14,045 15.6 339.8

45–64 years ............................... 6,629 7.4 263.1

65–74 years ............................... 3,350 3.7 328.6

75 years and over ........................... 4,342 4.8 563.5

Male ..................................... 43,184 48.1 353.4

Under 15 years ............................. 12,327 13.7 426.7

15–24 years ............................... 6,797 7.6 397.5

25–44 years ............................... 13,195 14.7 329.9

45–64 years ............................... 5,880 6.5 252.3

65–74 years ............................... 2,456 2.7 296.8

75 years and over ........................... 2,529 2.8 547.8

Race and age

White .................................... 70,478 78.5 336.5

Under 15 years ............................. 16,878 18.8 375.2

15–24 years ............................... 11,598 12.9 422.1

25–44 years ............................... 20,579 22.9 303.9

45–64 years ............................... 10,134 11.3 242.8

65–74 years ............................... 5,017 5.6 306.2

75 years and over ........................... 6,272 7.0 562.3

Black ..................................... 17,150 19.1 545.1

Under 15 years ............................. 5,132 5.7 573.1

15–24 years ............................... 2,877 3.2 564.1

25–44 years ............................... 5,840 6.5 596.2

45–64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,111 2.4 423.0

65–74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 685 0.8 416.5

75 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . 505 0.6 516.8

All other races2 .............................. 2,168 2.4 206.1

1Based on U.S. Bureau of the Census estimates of the civilian noninstitutionalized population of the United States as of July 1, 1992.

2Includes Asians/Pacific Islanders and American Indians/Eskimos/Aleuts.

18
Table 2. Number, percent distribution, and annual rate of emergency department visits by patient’s age, sex, and race, according to

geographic region of visit: United States, 1992

Patient characteristic

All

regions

Geographic region of visit

Northeast Midwest South West

Age Number of visits in thousands

All ages ................................... 89,796 16,950 25,790 29,542 17,514

Under 15 years ............................. 22,523 3,658 6,740 7,792 4,334

15–24 years ............................... 14,848 2,821 4,476 4,572 2,978

25–44 years ............................... 27,240 5,281 7,558 8,723 5,678

45–64 years ............................... 12,509 2,541 3,474 4,183 2,312

65–74 years ............................... 5,806 1,247 1,557 1,924 1,077

75 years and over ........................... 6,871 1,402 1,985 2,348 1,135

Sex

Female ................................... 46,612 8,641 13,093 15,700 9,179

Male ..................................... 43,184 8,309 12,697 13,842 8,336

Race1

White .................................... 70,478 13,404 20,433 21,078 15,563

Black ..................................... 17,150 2,883 4,888 8,258 1,120

Age Percent distribution

All ages ................................... 100.0 100.0 100.0 100.0 100.0

Under 15 years ............................. 25.1 21.6 26.1 26.4 24.7

15–24 years ............................... 16.5 16.6 17.4 15.5 17.0

25–44 years ............................... 30.3 31.2 29.3 29.5 32.4

45–64 years ............................... 13.9 15.0 13.5 14.2 13.2

65–74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.5 7.4 6.0 6.5 6.1

75 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.7 8.3 7.7 7.9 6.5

Sex

Female ................................... 51.9 51.0 50.8 53.1 52.4

Male ..................................... 48.1 49.0 49.2 46.9 47.6

Race1

White .................................... 78.5 79.1 79.2 71.3 88.9

Black ..................................... 19.1 17.0 19.0 28.0 6.4

Age Number of visits per 1,000 persons2

All ages ................................... 357.1 339.0 419.5 349.9 315.3

Under 15 years ............................. 399.0 350.8 492.9 409.8 325.1

15–24 years ............................... 431.8 443.4 508.6 393.3 392.0

25–44 years ............................... 334.9 325.9 382.5 324.2 307.6

45–64 years ............................... 257.9 249.4 295.6 257.2 224.5

65–74 years ............................... 314.3 307.6 356.1 300.1 296.5

75 years and over ........................... 557.6 506.6 637.0 558.7 507.8

Sex

Female ................................... 360.6 333.7 413.3 360.7 325.9

Male ..................................... 353.4 344.7 426.1 338.5 304.3

Race1

White .................................... 336.5 312.1 379.0 320.5 332.2

Black ..................................... 545.1 534.3 761.5 485.3 426.2

1Estimates for races other than white and black have been omitted because of small sample sizes.

2Based on U.S. Bureau of the Census estimates of the civilian noninstitutionalized population of the United States as of July 1, 1992.

NOTE: Numbers may not add to totals because of rounding.

19
Table 3. Number, percent distribution, and annual rate of emergency department visits by major reason for visit, according to patient’s

age, sex, and race: United States, 1992

Patient characteristic

Major reason for visit

All

visits

Illness related1 Injury related2 Other

and

unknown

reason3 Total

First

visit

Followup

visit Total

First

visit

Followup

visit Unknown

Age Number of visits in thousands

All ages ................................... 89,796 50,931 48,224 2,707 33,950 29,856 3,308 787 4,915

Under 15 years ............................. 22,523 13,156 12,580 576 8,714 7,707 779 228 653

15–24 years ............................... 14,848 7,146 6,760 387 6,937 6,149 596 192 765

25–44 years ............................... 27,240 14,082 13,212 870 11,277 9,805 1,247 225 1,881

45–64 years ............................... 12,509 7,716 7,264 452 3,959 3,461 418 80 834

65–74 years ............................... 5,806 3,967 3,764 203 1,458 1,270 163 * 381

75 years and over ........................... 6,871 4,864 4,644 220 1,604 1,463 104 * 402

Sex

Female ................................... 46,612 28,972 27,432 1,540 14,812 13,143 1,287 382 2,828

Male ..................................... 43,184 21,959 20,791 1,168 19,138 16,712 2,021 405 2,087

Race4

White .................................... 70,478 38,790 36,823 1,967 28,154 24,906 2,647 602 3,534

Black ..................................... 17,150 10,984 10,305 679 4,987 4,250 573 164 1,179

Age Percent distribution

All ages ................................... 100.0 56.7 53.7 3.0 37.8 33.2 3.7 0.9 5.5

Under 15 years ............................. 100.0 58.4 55.9 2.6 38.7 34.2 3.5 1.0 2.9

15–24 years ............................... 100.0 48.1 45.5 2.6 46.7 41.4 4.0 1.3 5.1

25–44 years ............................... 100.0 51.7 48.5 3.2 41.4 36.0 4.6 0.8 6.9

45–64 years ............................... 100.0 61.7 58.1 3.6 31.6 27.7 3.3 0.6 6.7

65–74 years ............................... 100.0 68.3 64.8 3.5 25.1 21.9 2.8 * 6.6

75 years and over ........................... 100.0 70.8 67.6 3.2 23.3 21.3 1.5 * 5.9

Sex

Female ................................... 100.0 62.2 58.9 3.3 31.8 28.2 2.8 0.8 6.1

Male ..................................... 100.0 50.8 48.1 2.7 44.3 38.7 4.7 0.9 4.8

Race4

White .................................... 100.0 55.0 52.2 2.8 39.9 35.3 3.8 0.9 5.0

Black ..................................... 100.0 64.0 60.1 4.0 29.1 24.8 3.3 1.0 6.9

Age Number of visits per 1,000 persons5

All ages ................................... 357.1 202.6 191.8 10.8 135.0 118.7 13.2 3.1 19.5

Under 15 years ............................. 399.0 233.1 222.9 10.2 154.4 136.6 13.8 4.0 11.6

15–24 years ............................... 431.8 207.8 196.6 11.2 201.7 178.8 17.3 5.6 22.2

25–44 years ............................... 334.9 173.2 162.5 10.7 138.7 120.6 15.3 2.8 23.1

45–64 years ............................... 257.9 159.1 149.8 9.3 81.6 71.4 8.6 1.7 17.2

65–74 years ............................... 314.3 214.8 203.8 11.0 79.0 68.8 8.8 * 20.6

75 years and over ........................... 557.6 394.7 376.9 17.8 130.2 118.7 8.5 * 32.7

Sex

Female ................................... 360.6 224.1 212.2 11.9 114.6 101.7 10.0 3.0 21.9

Male ..................................... 353.4 179.7 170.2 9.6 156.6 136.8 16.5 3.3 17.1

Race4

White .................................... 336.5 185.2 175.8 9.4 134.4 118.9 12.6 2.9 16.9

Black ..................................... 545.1 349.1 327.5 21.6 158.5 135.1 18.2 5.2 37.5

* Figure does not meet standard of reliability or precision.

1Includes visits described as illness related in item 9 of the Patient Record form which did not have a specified cause of injury in item 10.

2Includes all visits described as injury related in item 9 or with a cause of injury specified in item 10. Three percent of the 52,528,000 visits described as ‘‘illness related’’ in item 9 reported a cause

of injury in item 10, and 14 percent of the 5,701,000 visits made for other or unspecified reasons in item 9 reported a cause of injury in item 10.

3Includes preadmission examination. First or followup visit status was not collected for these visits.

4Estimates for races other than white and black have been omitted because of small sample sizes.

5Based on U.S. Bureau of the Census estimates of the civilian noninstitutionalized population of the United States as of July 1, 1992.

NOTE: Numbers may not add to totals because of rounding.

20
Table 4. Number and percent distribution of emergency department visits by patient’s principal reason for visit, according to patient’s

age, sex, and race: United States, 1992

Principal reason for visit and RVC code1

Age Sex Race2

All

ages

Under

15 years

15–24

years

25–44

years

45–64

years

65–74

years

75 years

and over Female Male White Black

Number of visits in thousands

All visits ..................................... 89,796 22,523 14,848 27,240 12,509 5,806 6,871 46,612 43,184 70,478 17,150

Symptom module ........................ S001–S999 64,048 15,631 10,263 18,889 9,158 4,636 5,471 35,355 28,693 49,812 12,698

General symptoms ...................... S001–S099 13,614 3,873 1,385 3,303 2,301 1,189 1,563 7,098 6,517 10,708 2,597

Symptoms referable to psychological/mental

disorders ........................... S100–S199 1,399 266 183 597 164 64 123 669 729 1,043 278

Symptoms referable to the nervous system

(excluding sense organs) ................. S200–S259 5,350 520 879 1,998 1,009 427 516 3,069 2,281 4,174 994

Symptoms referable to the cardiovascular/

lymphatic system ...................... S260–S299 659 * * 193 133 118 102 406 253 560 88

Symptoms referable to the eyes and ears ........ S300–S399 3,426 1,512 496 977 286 72 * 1,753 1,673 2,610 748

Symptoms referable to the respiratory system ..... S400–S499 10,333 3,687 1,230 2,258 1,239 976 943 5,817 4,516 7,853 2,256

Symptoms referable to the digestive system ...... S500–S639 10,359 2,483 2,061 2,908 1,351 692 865 6,121 4,238 8,000 2,124

Symptoms referable to the genitourinary

system ............................ S640–S829 3,131 264 1,005 1,149 315 153 244 2,304 827 2,220 833

Symptoms referable to the skin, hair, and

nails .............................. S830–S899 2,453 1,006 355 603 257 137 96 1,184 1,269 1,838 551

Symptoms referable to the musculoskeletal

system ............................ S900–S999 13,324 1,967 2,607 4,904 2,104 808 934 6,933 6,391 10,807 2,230

Disease module ........................ D001–D999 2,828 488 388 1,046 549 179 179 1,561 1,266 2,004 754

Diagnostic, screening, and preventive module ...... X100–X599 754 116 134 289 107 * * 451 302 545 196

Treatment module ........................ T100–T899 2,364 513 325 884 380 159 102 973 1,391 1,852 457

Injuries and adverse effects module ............. J001–J999 18,261 5,389 3,473 5,654 2,117 679 949 7,517 10,744 15,045 2,778

Other3 ...................................... 1,542 386 264 479 199 92 122 755 787 1,219 266

Percent distribution

All visits ..................................... 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Symptom module ........................ S001–S999 71.3 69.4 69.1 69.3 73.2 79.9 79.6 75.8 66.4 70.7 74.0

General symptoms ...................... S001–S099 15.2 17.2 9.3 12.1 18.4 20.5 22.8 15.2 15.1 15.2 15.1

Symptoms referable to psychological/mental

disorders ........................... S100–S199 1.6 1.2 1.2 2.2 1.3 1.1 1.8 1.4 1.7 1.5 1.6

Symptoms referable to the nervous system

(excluding sense organs) ................. S200–S259 6.0 2.3 5.9 7.3 8.1 7.4 7.5 6.6 5.3 5.9 5.8

Symptoms referable to the cardiovascular/lymphatic

system ............................ S260–S299 0.7 * * 0.7 1.1 2.0 1.5 0.9 0.6 0.8 0.5

Symptoms referable to the eyes and ears ........ S300–S399 3.8 6.7 3.3 3.6 2.3 1.2 * 3.8 3.9 3.7 4.4

Symptoms referable to the respiratory system ..... S400–S499 11.5 16.4 8.3 8.3 9.9 16.8 13.7 12.5 10.5 11.1 13.2

Symptoms referable to the digestive system ...... S500–S639 11.5 11.0 13.9 10.7 10.8 11.9 12.6 13.1 9.8 11.4 12.4

Symptoms referable to the genitourinary

system ............................ S640–S829 3.5 1.2 6.8 4.2 2.5 2.6 3.6 4.9 1.9 3.2 4.9

Symptoms referable to the skin, hair, and

nails .............................. S830–S899 2.7 4.5 2.4 2.2 2.1 2.4 1.4 2.5 2.9 2.6 3.2

Symptoms referable to the musculoskeletal

system ............................ S900–S999 14.8 8.7 17.6 18.0 16.8 13.9 13.6 14.9 14.8 15.3 13.0

Disease module ........................ D001–D999 3.1 2.2 2.6 3.8 4.4 3.1 2.6 3.3 2.9 2.8 4.4

Diagnostic, screening, and preventive module ...... X100–X599 0.8 0.5 0.9 1.1 0.9 * * 1.0 0.7 0.8 1.1

Treatment module ........................ T100–T899 2.6 2.3 2.2 3.2 3.0 2.7 1.5 2.1 3.2 2.6 2.7

Injuries and adverse effects module ............. J001–J999 20.3 23.9 23.4 20.8 16.9 11.7 13.8 16.1 24.9 21.3 16.2

Other3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.7 1.7 1.8 1.8 1.6 1.6 1.8 1.6 1.8 1.7 1.5

* Figure does not meet standard of reliability or precision.

1Based on A Reason for Visit Classification for Ambulatory Care (RVC) (10).

2Estimates for races other than white and black have been omitted because of small sample sizes.

3Includes test results module (R100–R700), administrative module (A100–A140), and other reasons (U990–U999). ‘‘Other’’ includes problems and complaints not elsewhere classified, entries of

‘‘none,’’ blanks, and illegible entries.

NOTE: Numbers may not add to totals because of rounding.

21
Table 5. Number, percent distribution, and annual rate of emergency department visits by the 60 principal reasons for visit most often

mentioned by patients: United States, 1992

Rank Reason for visit and RVC code1

Number

of visits

in thousands

Percent

distribution

Number of visits

per 1,000 persons

per year2

. . . All visits ............................................. 89,796 100.0 357.1

1 Stomach and abdominal pain, cramps, and spasms .............. S545 4,955 5.5 19.7

2 Chest pain and related symptoms (not referable to body system) ...... S050 4,625 5.2 18.4

3 Fever .......................................... S010 3,678 4.1 14.6

4 Headache, pain in head ............................... S210 2,545 2.8 10.1

5 Lacerations and cuts of upper extremity ..................... J225 2,347 2.6 9.3

6 Shortness of breath .................................. S415 2,025 2.3 8.1

7 Cough .......................................... S440 1,997 2.2 7.9

8 Back symptoms .................................... S905 1,959 2.2 7.8

9 Symptoms referable to throat ............................ S455 1,957 2.2 7.8

10 Vomiting ......................................... S530 1,877 2.1 7.5

11 Pain, site not referable to specific body system ................. S055 1,812 2.0 7.2

12 Earache or ear infection ............................... S355 1,614 1.8 6.4

13 Lacerations and cuts of facial area ........................ J210 1,485 1.7 5.9

14 Hand and finger symptoms ............................. S960 1,390 1.5 5.5

15 Neck symptoms .................................... S900 1,325 1.5 5.3

16 Skin rash ........................................ S860 1,305 1.5 5.2

17 Labored or difficult breathing (dyspnea) ..................... S420 1,239 1.4 4.9

18 Leg symptoms ..................................... S920 1,154 1.3 4.6

19 Knee symptoms .................................... S925 1,102 1.2 4.4

20 Foot and toe symptoms ............................... S935 1,085 1.2 4.3

21 Head, neck, and face injury, type unspecified .................. J505 1,078 1.2 4.3

22 Vertigo-dizziness ................................... S225 1,066 1.2 4.2

23 Low back symptoms ................................. S910 1,061 1.2 4.2

24 Hand and finger(s) injury, type unspecified .................... J570 996 1.1 4.0

25 Shoulder symptoms .................................. S940 923 1.0 3.7

26 Nausea ......................................... S525 909 1.0 3.6

27 Ankle symptoms .................................... S930 891 1.0 3.5

28 Arm symptoms ..................................... S945 868 1.0 3.5

29 Pain and related symptoms, generalized, site unspecified .......... S060 827 0.9 3.3

30 Convulsions ...................................... S205 796 0.9 3.2

31 Suture-insertion, removal .............................. T555 755 0.8 3.0

32 Head cold, upper respiratory infection (coryza) ................. S445 751 0.8 3.0

33 Lacerations and cuts of the head and neck area ................ J205 733 0.8 2.9

34 Accident, not otherwise specified ......................... J810 700 0.8 2.8

35 Nasal congestion ................................... S400 686 0.8 2.7

36 Wrist symptoms .................................... S955 660 0.7 2.6

37 Abnormal sensations of the eye .......................... S320 654 0.7 2.6

38 Unconscious on arrival ................................ J840 631 0.7 2.5

39 Asthma ......................................... D625 613 0.7 2.4

40 General weakness .................................. S020 600 0.7 2.4

41 Lacerations and cuts of the lower extremity ................... J220 594 0.7 2.4

42 Diarrhea ......................................... S595 577 0.6 2.3

43 Lacerations and cuts, site unspecified ...................... J230 563 0.6 2.2

44 Motor vehicle accident, type of injury unspecified ............... J805 539 0.6 2.1

45 Uterine and vaginal bleeding ............................ S755 502 0.6 2.0

46 Abnormal pulsations and palpitations ....................... S260 499 0.6 2.0

47 Hip symptoms ..................................... S915 497 0.6 2.0

48 Painful urination .................................... S650 496 0.6 2.0

49 Fainting (syncope) .................................. S030 488 0.5 1.9

50 Wheezing ........................................ S425 486 0.5 1.9

51 Problems of pregnancy ............................... S790 480 0.5 1.9

52 Symptoms of teeth and gums ............................ S500 477 0.5 1.9

53 Disturbances of sensations ............................. S220 469 0.5 1.9

54 Migraine headache .................................. D365 460 0.5 1.8

55 Violence, not otherwise specified ......................... J815 441 0.5 1.8

56 Ankle injury, type unspecified ............................ J540 437 0.5 1.7

57 Foot and toe(s) injury, type unspecified...................... J545 433 0.5 1.7

58 Insect bite ........................................ J755 431 0.5 1.7

59 Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S110 418 0.5 1.7

60 Other symptoms of nose ............................... S405 415 0.5 1.7

. . . All other reasons ....................................... 22,421 25.0 89.2

. . . Category not applicable.

1Based on A Reason for Visit Classification for Ambulatory Care (RVC) (10).

2Based on U.S. Bureau of the Census estimates of the civilian noninstitutionalized population of the United States as of July 1, 1992.

NOTE: Numbers may not add to totals because of rounding.

22
Table 6. Number, percent distribution, and annual rate of emergency department visits by patient’s age, sex, race, and 10 most frequent

principal reasons for visit: United States, 1992

Selected patient characteristic,

principal reason for visit, and RVC code1

Number

of visits

in thousands

Percent

distribution

Number of visits

per 1,000 persons

per year2

Age

All ages:

All visits ................................................ 89,796 100.0 357.1

Stomach and abdominal pain, cramps, and spasms ................. S545 4,955 5.5 19.7

Chest pain and related symptoms (not referable to body system) ......... S050 4,625 5.2 18.4

Fever .............................................. S010 3,678 4.1 14.6

Headache, pain in head ................................... S210 2,545 2.8 10.1

Lacerations and cuts of upper extremity ......................... J225 2,347 2.6 9.3

Shortness of breath ..................................... S415 2,025 2.3 8.1

Cough .............................................. S440 1,997 2.2 7.9

Back symptoms ........................................ S905 1,959 2.2 7.8

Symptoms referable to throat ............................... S455 1,957 2.2 7.8

Vomiting ............................................ S530 1,877 2.1 7.5

All other reasons .......................................... 61,831 68.9 245.9

Under 15 years:

All visits ................................................ 22,523 100.0 399.0

Fever .............................................. S010 2,852 12.7 50.5

Cough .............................................. S440 1,096 4.9 19.4

Vomiting ............................................ S530 962 4.3 17.0

Earache or ear infection ................................... S355 942 4.2 16.7

Lacerations and cuts of facial area ............................ J210 741 3.3 13.1

Skin rash ............................................ S860 637 2.8 11.3

Stomach and abdominal pain, cramps, and spasms ................. S545 611 2.7 10.8

Symptoms referable to throat ............................... S455 563 2.5 10.0

Nasal congestion ....................................... S400 460 2.0 8.1

Head, neck, and face injury, type unspecified ..................... J505 415 1.8 7.4

All other reasons .......................................... 13,243 58.8 234.6

15–24 years:

All visits ................................................ 14,848 100.0 431.8

Stomach and abdominal pain, cramps, and spasms ................. S545 1,222 8.2 35.5

Lacerations and cuts of upper extremity ......................... J225 619 4.2 18.0

Symptoms referable to throat ............................... S455 502 3.4 14.6

Headache, pain in head ................................... S210 497 3.3 14.4

Chest pain and related symptoms (not referable to body system) ......... S050 399 2.7 11.6

Back symptoms ........................................ S905 392 2.6 11.4

Pain, site not referable to specific body system .................... S055 349 2.4 10.2

Hand and finger symptoms ................................. S960 346 2.3 10.1

Neck symptoms ........................................ S900 305 2.1 8.9

Ankle symptoms ....................................... S930 267 1.8 7.8

All other reasons .......................................... 9,950 67.0 289.4

25–44 years:

All visits ................................................ 27,240 100.0 334.9

Stomach and abdominal pain, cramps, and spasms ................. S545 1,759 6.5 21.6

Chest pain and related symptoms (not referable to body system) ......... S050 1,348 4.9 16.6

Headache, pain in head ................................... S210 1,154 4.2 14.2

Lacerations and cuts of upper extremity ......................... J225 880 3.2 10.8

Back symptoms ........................................ S905 875 3.2 10.8

Pain, site not referable to specific body system .................... S055 739 2.7 9.1

Symptoms referable to throat ............................... S455 686 2.5 8.4

Neck symptoms ........................................ S900 583 2.1 7.2

Low back symptoms ..................................... S910 541 2.0 6.7

Hand and finger symptoms ................................. S960 495 1.8 6.1

All other reasons .......................................... 18,180 66.7 223.5

45–64 years:

All visits ................................................ 12,509 100.0 257.9

Chest pain and related symptoms (not referable to body system) ......... S050 1,294 10.3 26.7

Stomach and abdominal pain, cramps, and spasms ................. S545 706 5.6 14.5

Headache, pain in head ................................... S210 421 3.4 8.7

Shortness of breath ..................................... S415 380 3.0 7.8

Pain, site not referable to specific body system .................... S055 374 3.0 7.7

23
Table 6. Number, percent distribution, and annual rate of emergency department visits by patient’s age, sex, race, and 10 most frequent

principal reasons for visit: United States, 1992—Con.

Selected patient characteristic,

principal reason for visit, and RVC code1

Number

of visits

in thousands

Percent

distribution

Number of visits

per 1,000 persons

per year2

45–64 years:—Con.

Back symptoms ........................................ S905 348 2.8 7.2

Lacerations and cuts of upper extremity ......................... J225 342 2.7 7.1

Leg symptoms ........................................ S920 248 2.0 5.1

Vertigo-dizziness ....................................... S225 244 2.0 5.0

Knee symptoms ........................................ S925 219 1.8 4.5

All other reasons .......................................... 7,934 63.4 163.6

65–74 years:

All visits ................................................ 5,806 100.0 314.3

Chest pain and related symptoms (not referable to body system) ......... S050 653 11.3 35.4

Shortness of breath ..................................... S415 488 8.4 26.4

Stomach and abdominal pain, cramps, and spasms ................. S545 297 5.1 16.1

Labored or difficult breathing (dyspnea) ......................... S420 196 3.4 10.6

Vertigo-dizziness ....................................... S225 168 2.9 9.1

Back symptoms ........................................ S905 118 2.0 6.4

Headache, pain in head ................................... S210 112 1.9 6.1

Vomiting ............................................ S530 112 1.9 6.1

General weakness ...................................... S020 109 1.9 5.9

Abnormal pulsations and palpitations ........................... S260 101 1.7 5.5

All other reasons .......................................... 3,453 59.5 186.9

75 years and over:

All visits ................................................ 6,871 100.0 557.6

Chest pain and related symptoms (not referable to body system) ......... S050 765 11.1 62.1

Shortness of breath ..................................... S415 455 6.6 36.9

Stomach and abdominal pain, cramps, and spasms ................. S545 360 5.2 29.2

Unconscious on arrival ................................... J840 235 3.4 19.0

General weakness ...................................... S020 215 3.1 17.5

Labored or difficult breathing (dyspnea) ......................... S420 190 2.8 15.5

Vertigo-dizziness ....................................... S225 178 2.6 14.5

Back symptoms ........................................ S905 162 2.4 13.2

Hip symptoms ......................................... S915 160 2.3 13.0

Fever .............................................. S010 149 2.2 12.1

All other reasons .......................................... 4,000 58.2 324.6

Sex

Female:

All visits ................................................ 46,612 100.0 360.6

Stomach and abdominal pain, cramps, and spasms ................. S545 3,137 6.7 24.3

Chest pain and related symptoms (not referable to body system) ......... S050 2,492 5.3 19.3

Fever .............................................. S010 1,800 3.9 13.9

Headache, pain in head ................................... S210 1,694 3.6 13.1

Symptoms referable to throat ............................... S455 1,186 2.5 9.2

Shortness of breath ..................................... S415 1,131 2.4 8.7

Cough .............................................. S440 1,092 2.3 8.4

Vomiting ............................................ S530 1,088 2.3 8.4

Back symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 905 1,084 2.3 8.4

Earache or ear infection ................................... S355 923 2.0 7.1

All other reasons .......................................... 30,986 66.5 239.7

Male:

All visits ................................................ 43,184 100.0 353.4

Chest pain and related symptoms (not referable to body system) ......... S050 2,134 4.9 17.5

Fever .............................................. S010 1,877 4.3 15.4

Stomach and abdominal pain, cramps, and spasms ................. S545 1,818 4.2 14.9

Lacerations and cuts of upper extremity ......................... J225 1,669 3.9 13.7

Lacerations and cuts of facial area ............................ J210 967 2.2 7.9

Pain, site not referable to specific body system .................... S055 930 2.2 7.6

Cough .............................................. S440 905 2.1 7.4

Shortness of breath ..................................... S415 894 2.1 7.3

Back symptoms ........................................ S905 875 2.0 7.2

Headache, pain in head ................................... S210 851 2.0 7.0

All other reasons .......................................... 30,263 70.1 247.7

24
Table 6. Number, percent distribution, and annual rate of emergency department visits by patient’s age, sex, race, and 10 most frequent

principal reasons for visit: United States, 1992—Con.

Selected patient characteristic,

principal reason for visit, and RVC code1

Number

of visits

in thousands

Percent

distribution

Number of visits

per 1,000 persons

per year2

Race3

White:

All visits ................................................ 70,478 100.0 336.5

Stomach and abdominal pain, cramps, and spasms ................. S545 3,843 5.5 18.3

Chest pain and related symptoms (not referable to body system) ......... S050 3,825 5.4 18.3

Fever .............................................. S010 2,686 3.8 12.8

Lacerations and cuts of upper extremity ......................... J225 2,049 2.9 9.8

Headache, pain in head ................................... S210 1,936 2.7 9.2

Shortness of breath ..................................... S415 1,648 2.3 7.9

Cough .............................................. S440 1,583 2.2 7.6

Back symptoms ........................................ S905 1,551 2.2 7.4

Symptoms referable to throat ............................... S455 1,478 2.1 7.1

Vomiting ............................................ S530 1,435 2.0 6.8

All other reasons .......................................... 48,443 68.7 231.3

Black:

All visits ................................................ 17,150 100.0 545.1

Stomach and abdominal pain, cramps, and spasms ................. S545 1,004 5.9 31.9

Fever .............................................. S010 896 5.2 28.5

Chest pain and related symptoms (not referable to body system) ......... S050 701 4.1 22.3

Headache, pain in head ................................... S210 507 3.0 16.1

Symptoms referable to throat ............................... S455 429 2.5 13.6

Vomiting ............................................ S530 401 2.3 12.7

Cough .............................................. S440 366 2.1 11.6

Back symptoms ........................................ S905 364 2.1 11.6

Pain, site not referable to specific body system .................... S055 342 2.0 10.9

Shortness of breath ..................................... S415 334 1.9 10.6

All other reasons .......................................... 11,805 68.8 375.2

1Based on A Reason for Visit Classification for Ambulatory Care (RVC) (10).

2Based on U.S. Bureau of the Census estimates of the civilian noninstitutionalized population of the United States as of July 1, 1992.

3Estimates for races other than white and black have been omitted because of small sample sizes.

NOTE: Numbers may not add to totals because of rounding.

25
Table 7. Number and percent distribution of emergency department visits by selected principal reasons for visit, according to patient’s

age, sex, and race: United States, 1992

Principal reason for visit

and RVC code1

Age Sex Race2

All

ages

Under

15 years

15–24

years

25–44

years

45–64

years

65 years

and over Female Male White Black

Number of visits in thousands

All visits ................................... 89,796 22,523 14,848 27,240 12,509 12,676 46,612 43,184 70,478 17,150

Stomach and abdominal pain, cramps, and spasms .... S545 4,955 611 1,222 1,759 706 657 3,137 1,818 3,843 1,004

Chest pain and related symptoms (not referable to

body system) ........................... S050 4,625 166 399 1,348 1,294 1,419 2,492 2,134 3,825 701

Fever ................................ S010 3,678 2,852 175 292 135 224 1,800 1,877 2,686 896

Headache, pain in head ..................... S210 2,545 265 497 1,154 421 209 1,694 851 1,936 507

Lacerations and cuts of upper extremity ........... J225 2,347 342 619 880 342 164 678 1,669 2,049 252

Shortness of breath ........................ S415 2,025 166 143 394 380 943 1,131 894 1,648 334

Cough ................................ S440 1,997 1,096 171 354 218 157 1,092 905 1,583 366

Back symptoms .......................... S905 1,959 * 392 875 348 280 1,084 875 1,551 364

Symptoms referable to throat .................. S455 1,957 563 502 686 122 83 1,186 771 1,478 429

Vomiting ............................... S530 1,877 962 227 290 163 235 1,088 789 1,435 401

Pain, site not referable to specific body system ....... S055 1,812 144 349 739 374 207 882 930 1,434 342

Earache or ear infection ..................... S355 1,614 942 207 328 109 * 923 691 1,263 330

Lacerations and cuts of facial area .............. J210 1,485 741 204 291 137 113 517 967 1,182 284

Hand and finger symptoms ................... S960 1,390 367 346 495 106 75 570 820 1,217 166

Neck symptoms .......................... S900 1,325 165 305 583 167 106 739 587 1,032 250

Skin rash .............................. S860 1,305 637 186 298 132 * 610 695 968 292

Labored or difficult breathing (dyspnea) ........... S420 1,239 336 91 216 209 386 688 551 1,032 182

Leg symptoms ........................... S920 1,154 184 143 349 248 230 542 612 882 256

Knee symptoms .......................... S925 1,102 141 207 416 219 118 486 616 900 179

Head, neck, and face injury, type unspecified ........ J505 1,078 415 225 278 90 * 434 644 888 173

Low back symptoms ....................... S910 1,061 * 216 541 159 117 564 496 820 220

Head cold, upper respiratory infection (coryza) ....... S445 751 397 * 138 * * 484 267 446 290

Asthma ............................... D625 613 258 122 157 *56 * 319 293 326 260

Wheezing .............................. S425 486 401 * * * * 208 278 252 224

All other reasons ............................. 45,417 10,280 7,808 14,355 6,286 6,687 23,265 22,152 35,800 8,449

Percent distribution

All visits ................................... 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Stomach and abdominal pain, cramps, and spasms .... S545 5.5 2.7 8.2 6.5 5.6 5.2 6.7 4.2 5.5 5.9

Chest pain and related symptoms (not referable to

body system) ........................... S050 5.2 0.7 2.7 4.9 10.3 11.2 5.3 4.9 5.4 4.1

Fever ................................ S010 4.1 12.7 1.2 1.1 1.1 1.8 3.9 4.3 3.8 5.2

Headache, pain in head ..................... S210 2.8 1.2 3.3 4.2 3.4 1.6 3.6 2.0 2.7 3.0

Lacerations and cuts of upper extremity ........... J225 2.6 1.5 4.2 3.2 2.7 1.3 1.5 3.9 2.9 1.5

Shortness of breath ........................ S415 2.3 0.7 1.0 1.4 3.0 7.4 2.4 2.1 2.3 1.9

Cough ................................ S440 2.2 4.9 1.2 1.3 1.7 1.2 2.3 2.1 2.2 2.1

Back symptoms .......................... S905 2.2 * 2.6 3.2 2.8 2.2 2.3 2.0 2.2 2.1

Symptoms referable to throat .................. S455 2.2 2.5 3.4 2.5 1.0 0.7 2.5 1.8 2.1 2.5

Vomiting ............................... S530 2.1 4.3 1.5 1.1 1.3 1.9 2.3 1.8 2.0 2.3

Pain, site not referable to specific body system ....... S055 2.0 0.6 2.4 2.7 3.0 1.6 1.9 2.2 2.0 2.0

Earache or ear infection ..................... S355 1.8 4.2 1.4 1.2 0.9 * 2.0 1.6 1.8 1.9

Lacerations and cuts of facial area .............. J210 1.7 3.3 1.4 1.1 1.1 0.9 1.1 2.2 1.7 1.7

Hand and finger symptoms ................... S960 1.5 1.6 2.3 1.8 0.8 0.6 1.2 1.9 1.7 1.0

Neck symptoms .......................... S900 1.5 0.7 2.1 2.1 1.3 0.8 1.6 1.4 1.5 1.5

Skin rash .............................. S860 1.5 2.8 1.3 1.1 1.1 * 1.3 1.6 1.4 1.7

Labored or difficult breathing (dyspnea) ........... S420 1.4 1.5 0.6 0.8 1.7 3.0 1.5 1.3 1.5 1.1

Leg symptoms ........................... S920 1.3 0.8 1.0 1.3 2.0 1.8 1.2 1.4 1.3 1.5

Knee symptoms .......................... S925 1.2 0.6 1.4 1.5 1.8 0.9 1.0 1.4 1.3 1.0

Head, neck, and face injury, type unspecified ........ J505 1.2 1.8 1.5 1.0 0.7 * 0.9 1.5 1.3 1.0

Low back symptoms ....................... S910 1.2 * 1.5 2.0 1.3 0.9 1.2 1.1 1.2 1.3

Head cold, upper respiratory infection (coryza) ....... S445 0.8 1.8 * 0.5 * * 1.0 0.6 0.6 1.7

Asthma ............................... D625 0.7 1.1 0.8 0.6 *0.4 * 0.7 0.7 0.5 1.5

Wheezing .............................. S425 0.5 1.8 * * * * 0.4 0.6 0.4 1.3

All other reasons ............................. 50.6 45.6 52.6 52.7 50.2 52.8 49.9 51.3 50.8 49.3

* Figure does not meet standard of reliability or precision.

1Based on A Reason for Visit Classification for Ambulatory Care (RVC) (10).

2Estimates for races other than white and black have been omitted because of small sample sizes.

NOTE: Numbers may not add to totals because of rounding.

26
Table 8. Number and percent distribution of emergency department visits by patient’s age, sex, and race, according to selected principal

reasons for visit: United States, 1992

Principal reason for visit and RVC code1

Number of

visits in

thousands Total

Age Sex Race2

Under

15 years

15–24

years

25–44

years

45–64

years

65 years

and over Female Male White Black

Percent distribution

All visits ..................................... 89,796 100.0 25.1 16.5 30.3 13.9 14.1 51.9 48.1 78.5 19.1

Stomach and abdominal pain, cramps, and spasms ....... S545 4,955 100.0 12.3 24.7 35.5 14.2 13.3 63.3 36.7 77.6 20.3

Chest pain and related symptoms (not referable to

body system) .............................. S050 4,625 100.0 3.6 8.6 29.1 28.0 30.7 53.9 46.1 82.7 15.2

Fever ................................... S010 3,678 100.0 77.5 4.8 7.9 3.7 6.1 48.9 51.1 73.0 24.4

Headache, pain in head ........................ S210 2,545 100.0 10.4 19.5 45.4 16.5 8.2 66.6 33.4 76.1 19.9

Lacerations and cuts of upper extremity .............. J225 2,347 100.0 14.6 26.4 37.5 14.6 7.0 28.9 71.1 87.3 10.7

Shortness of breath ........................... S415 2,025 100.0 8.2 7.0 19.5 18.8 46.6 55.8 44.2 81.4 16.5

Cough ................................... S440 1,997 100.0 54.9 8.6 17.7 10.9 7.9 54.7 45.3 79.3 18.3

Back symptoms ............................. S905 1,959 100.0 * 20.0 44.7 17.8 14.3 55.3 44.7 79.2 18.6

Symptoms referable to throat ..................... S455 1,957 100.0 28.8 25.6 35.1 6.3 4.3 60.6 39.4 75.5 21.9

Vomiting .................................. S530 1,877 100.0 51.3 12.1 15.5 8.7 12.5 58.0 42.0 76.4 21.4

Pain, site not referable to specific body system .......... S055 1,812 100.0 7.9 19.3 40.8 20.6 11.4 48.7 51.3 79.2 18.9

Earache or ear infection ........................ S355 1,614 100.0 58.4 12.8 20.3 6.8 * 57.2 42.8 78.2 20.4

Lacerations and cuts of facial area ................. J210 1,485 100.0 49.9 13.7 19.6 9.2 7.6 34.8 65.2 79.6 19.1

Hand and finger symptoms ...................... S960 1,390 100.0 26.4 24.9 35.6 7.6 5.4 41.0 59.0 87.6 12.0

Neck symptoms ............................. S900 1,325 100.0 12.4 23.0 44.0 12.6 8.0 55.7 44.3 77.9 18.9

Skin rash ................................. S860 1,305 100.0 48.8 14.3 22.8 10.2 * 46.7 53.3 74.2 22.4

Labored or difficult breathing (dyspnea) .............. S420 1,239 100.0 27.1 7.4 17.4 16.9 31.2 55.6 44.4 83.3 14.7

Leg symptoms .............................. S920 1,154 100.0 15.9 12.4 30.3 21.5 19.9 46.9 53.1 76.4 22.1

Knee symptoms ............................. S925 1,102 100.0 12.8 18.8 37.8 19.9 10.7 44.1 55.9 81.7 16.2

Head, neck, and face injury, type unspecified ........... J505 1,078 100.0 38.5 20.9 25.8 8.3 * 40.2 59.8 82.4 16.0

Low back symptoms .......................... S910 1,061 100.0 * 20.3 51.0 15.0 11.0 53.2 46.8 77.3 20.7

Head cold, upper respiratory infection (coryza) .......... S445 751 100.0 52.9 * 18.4 * * 64.5 35.5 59.4 38.6

Asthma .................................. D625 613 100.0 42.1 19.9 25.7 9.1 * 52.1 47.9 53.3 42.4

Wheezing ................................. S425 486 100.0 82.4 * * * * 42.7 57.3 51.8 46.0

All other reasons ............................... 45,417 100.0 22.6 17.2 31.6 13.8 14.7 51.2 48.8 78.8 18.6

* Figure does not meet standard of reliability or precision.

1Based on A Reason for Visit Classification for Ambulatory Care (RVC) (10).

2Estimates for races other than white and black have been omitted because of small sample sizes.

NOTE: Numbers may not add to totals because of rounding.

27
Table 9. Number, percent distribution, and annual rate of injury-related emergency department visits by patient’s age, sex, and race, and

geographic region of the visit: United States, 1992

Selected patient and

emergency department characteristics

Number of

visits in

thousands

Percent

distribution

Number of visits

per 1,000 persons

per year1

Patient characteristic

All injury-related visits .......................... 33,950 100.0 135.0

Age:

Under 15 years ............................. 8,714 25.7 154.4

15–24 years ............................... 6,937 20.4 201.7

25–44 years ............................... 11,277 33.2 138.7

45–64 years ............................... 3,959 11.7 81.6

65–74 years ............................... 1,458 4.3 78.9

75 years and over ........................... 1,605 4.7 130.2

Sex and age:

Female .................................. 14,812 43.6 114.6

Under 15 years ............................ 3,567 10.5 129.5

15–24 years ............................. 2,670 7.9 154.4

25–44 years ............................. 4,714 13.9 114.0

45–64 years ............................. 1,796 5.3 71.3

65–74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 940 2.8 92.2

75 years and over .......................... 1,124 3.3 145.9

Male ..................................... 19,138 56.4 156.6

Under 15 years ............................. 5,147 15.2 178.1

15–24 years ............................... 4,267 12.6 249.6

25–44 years ............................... 6,564 19.3 164.1

45–64 years ............................... 2,163 6.4 92.8

65–74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 518 1.5 62.6

75 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . 480 1.4 104.0

Race and age:

White ................................... 28,154 82.9 134.4

Under 15 years ............................ 7,227 21.3 160.7

15–24 years ............................. 5,823 17.2 211.9

25–44 years ............................. 8,970 26.4 132.5

45–64 years ............................. 3,331 9.8 79.8

65–74 years ............................. 1,283 3.8 78.4

75 years and over .......................... 1,520 4.5 136.3

Black ..................................... 4,987 14.7 158.5

Under 15 years ............................. 1,311 3.9 146.4

15–24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 972 2.9 190.7

25–44 years ............................... 1,974 5.8 201.5

45–64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 524 1.5 105.1

65–74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 0.4 83.9

75 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 0.2 68.9

All other races2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 808 2.4 76.8

Emergency department characteristic

Geographic region:

Northeast ................................. 6,787 20.0 135.7

Midwest .................................. 9,877 29.1 160.7

South ................................... 10,448 30.8 123.8

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,838 20.1 123.1

1Based on U.S. Bureau of the Census estimates of the civilian, noninstitutionalized population of the United States as of July 1, 1992.

2Includes Asians/Pacific Islanders and American Indians/Eskimos/Aleuts.

NOTE: Numbers may not add to totals because of rounding.

28
Table 10. Number and percent distribution of injury-related emergency department visits by the 20 most frequent principal reasons for

visit, according to patient’s age, sex, and race: United States, 1992

Principal reason for visit and RVC code1 All ages

Age Sex Race2

Under

15 years

15–24

years

25–44

years

45–64

years

65 years

and over Female Male White Black

Number of visits in thousands

All injury-related visits3 .......................... 33,950 8,714 6,937 11,277 3,959 3,063 14,812 19,138 28,154 4,987

Lacerations and cuts of upper extremity ........... J225 2,321 339 610 877 332 163 664 1,657 2,027 248

Lacerations and cuts of facial area .............. J210 1,483 739 204 291 137 113 517 966 1,182 283

Hand and finger symptoms ................... S960 1,225 344 333 421 * * 473 751 1,090 130

Head, neck, and face injury, type unspecified ........ J505 1,065 407 225 273 90 * 426 638 879 171

Hand and finger(s) injury, type unspecified .......... J570 993 308 189 375 96 * 329 664 815 139

Neck symptoms .......................... S900 933 90 275 410 119 *39 511 421 720 178

Back symptoms .......................... S905 913 * 220 421 136 95 436 477 757 131

Knee symptoms .......................... S925 880 131 180 324 154 92 381 499 726 134

Ankle symptoms .......................... S930 838 150 255 264 115 * 438 399 723 98

Foot and toe symptoms ..................... S935 780 161 147 294 136 * 412 367 646 124

Lacerations and cuts of head and neck area ........ J205 728 316 84 164 * 114 249 479 617 84

Suture-insertion/removal ..................... T555 693 289 110 198 * * 195 498 543 134

Accident, not otherwise specified ............... J810 687 290 * 157 * 147 372 315 583 81

Shoulder symptoms ........................ S940 642 * 146 230 115 75 288 354 517 107

Arm symptoms ........................... S945 635 268 90 157 * * 380 256 528 92

Pain, site not referable to a specific body system ..... S055 621 * 136 241 112 66 272 349 516 93

Headache, pain in head ..................... S210 621 78 197 255 * * 349 272 442 135

Leg symptoms ........................... S920 601 139 102 167 85 109 236 365 503 94

Low back symptoms ....................... S910 601 * 107 326 92 * 248 352 441 141

Wrist symptoms .......................... S955 591 173 161 146 * * 312 279 547 *

All other reasons ............................. 16,099 4,290 3,127 5,286 1,854 1,542 7,321 8,779 13,353 2,372

Percent distribution

All injury-related visits3 .......................... 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Lacerations and cuts of upper extremity ........... J225 6.8 3.9 8.8 7.8 8.4 5.3 4.5 8.7 7.2 5.0

Lacerations and cuts of facial area .............. J210 4.4 8.5 2.9 2.6 3.5 3.7 3.5 5.0 4.2 5.7

Hand and finger symptoms ................... S960 3.6 3.9 4.8 3.7 * * 3.2 3.9 3.9 2.6

Head, neck, and face injury, type unspecified ........ J505 3.1 4.7 3.3 2.4 2.3 * 2.9 3.3 3.1 3.4

Hand and finger(s) injury, type unspecified .......... J570 2.9 3.5 2.7 3.3 * * 2.2 3.5 2.9 2.8

Neck symptoms .......................... S900 2.7 1.0 4.0 3.6 3.0 * 3.5 2.2 2.6 3.6

Back symptoms .......................... S905 2.7 * 3.2 3.7 3.4 3.1 2.9 2.5 2.7 2.6

Knee symptoms .......................... S925 2.6 1.5 2.6 2.9 3.9 3.0 2.6 2.6 2.6 2.7

Ankle symptoms .......................... S930 2.5 1.7 3.7 2.3 2.9 * 3.0 2.1 2.6 2.0

Foot and toe symptoms ..................... S935 2.3 1.9 2.1 2.6 3.4 * 2.8 1.9 2.3 2.5

Lacerations and cuts of head and neck area ........ J205 2.1 3.6 1.2 1.5 * 3.7 1.7 2.5 2.2 1.7

Suture-insertion/removal ..................... T555 2.0 3.3 1.6 1.8 * * 1.3 2.6 1.9 2.7

Accident, not otherwise specified ............... J810 2.0 3.3 * 1.4 * 4.8 2.5 1.6 2.1 1.6

Shoulder symptoms ........................ S940 1.9 * 2.1 2.0 2.9 2.5 1.9 1.8 1.8 2.1

Arm symptoms ........................... S945 1.9 3.1 1.3 1.4 * * 2.6 1.3 1.9 1.8

Pain, site not referable to a specific body system ..... S055 1.8 * 2.0 2.1 2.8 2.2 1.8 1.8 1.8 1.9

Headache, pain in head ..................... S210 1.8 0.9 2.8 2.3 * * 2.4 1.4 1.6 2.7

Leg symptoms ........................... S920 1.8 1.6 1.5 1.5 2.2 3.6 1.6 1.9 1.8 1.9

Low back symptoms ....................... S910 1.8 * 1.5 2.9 2.3 * 1.7 1.8 1.6 2.8

Wrist symptoms .......................... S955 1.7 2.0 2.3 1.3 * * 2.1 1.5 1.9 *

All other reasons ............................. 47.4 49.2 45.1 46.9 46.8 50.3 49.4 45.9 47.4 47.6

* Figure does not meet standard of reliability or precision.

1Based on A Reason for Visit Classification for Ambulatory Care (RVC) (10).

2Estimates for races other than white and black have been omitted because of small sample sizes.

3Visits were considered to be injury related if ‘‘injury, first visit’’ or ‘‘injury, followup visit’’ was checked in item 9 of the Patient Record form, or if a cause of injury was reported in item 10 of the

Patient Record form.

NOTE: Numbers may not add to totals because of rounding.

29
Table 11. Number and percent distribution of injury-related emergency department visits by patient’s age, sex, and race, according to the

20 most frequent principal reasons for visit: United States, 1992

Principal reason for visit and RVC code1

Number of

visits in

thousands

Age Sex Race2

Total

Under

15 years

15–24

years

25–44

years

45–64

years

65 years

and over Female Male White Black

Percent distribution

All injury-related visits3 .......................... 33,950 100.0 25.7 20.4 33.2 11.7 9.0 43.6 56.4 82.9 14.7

Lacerations and cuts of upper extremity ........... J225 2,321 100.0 14.6 26.3 37.8 14.3 7.0 28.6 71.4 87.3 10.7

Lacerations and cuts of facial area .............. J210 1,483 100.0 49.8 13.7 19.6 9.2 7.6 34.9 65.1 79.7 19.1

Hand and finger symptoms ................... S960 1,225 100.0 28.1 27.2 34.4 * * 38.6 61.4 89.0 10.6

Head, neck, and face injury, type unspecified ........ J505 1,065 100.0 38.3 21.2 25.7 8.5 * 40.1 59.9 82.5 16.1

Hand and finger(s) injury, type unspecified .......... J570 993 100.0 31.0 19.0 37.8 * * 33.2 66.8 82.1 14.0

Neck symptoms .......................... S900 933 100.0 9.7 29.5 43.9 12.8 * 54.8 45.2 77.2 19.0

Back symptoms .......................... S905 913 100.0 * 24.1 46.1 14.9 10.5 47.8 52.2 82.9 14.3

Knee symptoms .......................... S925 880 100.0 14.8 20.4 36.8 17.5 10.4 43.3 56.7 82.5 15.2

Ankle symptoms .......................... S930 838 100.0 17.9 30.5 31.5 13.7 * 52.3 47.7 86.3 11.6

Foot and toe symptoms ..................... S935 780 100.0 20.7 18.9 37.7 17.5 * 52.9 47.1 82.9 15.9

Lacerations and cuts of head and neck area ........ J205 728 100.0 43.4 11.6 22.5 * 15.7 34.3 65.7 84.8 11.6

Suture-insertion/removal ..................... T555 693 100.0 41.6 15.9 28.6 * * 28.2 71.8 78.3 19.4

Accident, not otherwise specified ............... J810 687 100.0 42.2 * 22.8 * 21.4 54.1 45.9 84.8 11.8

Shoulder symptoms ........................ S940 642 100.0 * 22.7 35.9 17.9 11.7 44.9 55.1 80.6 16.6

Arm symptoms ........................... S945 635 100.0 42.2 14.1 24.8 * * 59.8 40.2 83.2 14.4

Pain, site not referable to a specific body system ..... S055 621 100.0 * 22.0 38.8 18.0 10.6 43.8 56.2 83.1 15.0

Headache, pain in head ..................... S210 621 100.0 12.6 31.7 41.1 * * 56.2 43.8 71.1 21.8

Leg symptoms ........................... S920 601 100.0 23.1 16.9 27.7 14.2 18.2 39.2 60.8 83.7 15.6

Low back symptoms ....................... S920 601 100.0 * 17.7 54.3 15.2 * 41.3 58.7 73.3 23.4

Wrist symptoms .......................... S910 591 100.0 29.2 27.3 24.7 * * 52.8 47.2 92.6 *

All other reasons ............................. 16,100 100.0 26.6 19.4 32.8 11.5 9.6 45.5 54.5 82.9 14.7

* Figure does not meet standard of reliability or precision.

1Based on A Reason for Visit Classification for Ambulatory Care (RVC) (10).

2Estimates for races other than white and black have been omitted because of small sample sizes.

3Visits were considered to be injury related if ‘‘injury, first visit’’ or ‘‘injury, followup visit’’ was checked in item 9 of the Patient Record form, or if a cause of injury was reported in item 10 of the

Patient Record form.

NOTE: Numbers may not add to totals because of rounding.

30
Table 12. Number and percent distribution of injury-related emergency department visits by the 20 most frequent principal diagnoses,

according to patient’s age, sex, and race: United States, 1992

Principal diagnosis and ICD–9–CM code1

All

ages

Age Sex Race2

Under

15 years

15–24

years

25–44

years

45–64

years

65 years

and over Female Male White Black

Number of visits in thousands

All injury-related visits3 ................................. 33,950 8,714 6,937 11,277 3,959 3,063 14,812 19,138 28,154 4,987

Other open wound of head . . . . . . . . . . . . . . . . . . . . . . . . . . . 873 2,561 1,234 336 511 216 263 899 1,662 2,106 405

Confusion of lower limb and of other and unspecified sites . . . . . . . 924 1,755 378 355 618 252 151 900 856 1,405 321

Open wound of fingers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 883 1,604 220 401 636 266 * 515 1,088 1,403 165

Sprains and strains of other and unspecified parts of back . . . . . . . . 847 1,597 76 461 796 144 120 721 876 1,233 311

Sprains and strains of ankle and foot . . . . . . . . . . . . . . . . . . . . . 845 1,311 288 409 444 126 * 600 712 1,119 171

Open wound of other and unspecified sites, except limbs . . . . . . . . 879 1,257 461 236 335 138 * 561 696 1,024 187

Contusion of upper limb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 923 1,255 302 312 438 128 * 648 607 1,108 103

Contusion of face, scalp, and neck except eye(s) . . . . . . . . . . . . . 920 863 311 225 213 * * 441 422 716 120

Contusion of trunk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 922 744 119 211 265 * 77 374 371 616 105

Injury, other and unspecified . . . . . . . . . . . . . . . . . . . . . . . . . . 959 720 176 147 274 * * 333 387 572 129

Open wound of hand except finger(s) alone . . . . . . . . . . . . . . . . . 882 675 96 170 316 61 * 175 501 558 105

Intracranial injury of other and unspecified nature . . . . . . . . . . . . . 854 564 233 135 132 * * 227 336 458 96

Open wound of knee, leg (except thigh), and ankle . . . . . . . . . . . . 891 548 193 142 126 * * 181 367 455 80

Other and unspecified aftercare . . . . . . . . . . . . . . . . . . . . . . . . V58 540 192 117 138 * * 166 375 459 *

Fracture of radius and ulna . . . . . . . . . . . . . . . . . . . . . . . . . . . 813 518 315 * * * * 253 265 482 *

Sprains and strains of wrist and hand . . . . . . . . . . . . . . . . . . . . . 842 518 206 120 175 * * 246 271 472 *

Sprains and strains of knee and leg . . . . . . . . . . . . . . . . . . . . . . 844 509 * 150 220 * * 177 331 436 63

Fracture of one or more phalanges of hand . . . . . . . . . . . . . . . . . 816 482 186 104 123 * * 137 345 411 *

Superficial injury of eye and adnexa . . . . . . . . . . . . . . . . . . . . . 918 442 90 73 244 * * 219 223 400 *

Other and unspecified disorders of back . . . . . . . . . . . . . . . . . . . 724 392 * * 191 76 * 204 188 309 80

All other diagnoses ................................... 15,095 3,541 2,742 5,030 2,020 1,763 6,835 8,260 12,412 2,323

Percent distribution

All injury-related visits3 ................................. 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Other open wound of head . . . . . . . . . . . . . . . . . . . . . . . . . . . 873 7.5 14.2 4.9 4.5 5.5 8.6 6.1 8.7 7.5 8.1

Confusion of lower limb and of other and unspecified sites . . . . . . . 924 5.2 4.3 5.1 5.5 6.4 4.9 6.1 4.5 5.0 6.4

Open wound of fingers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 883 4.7 2.5 5.8 5.6 6.7 * 3.5 5.7 5.0 3.3

Sprains and strains of other and unspecified parts of back . . . . . . . . 847 4.7 0.9 6.6 7.1 3.6 3.9 4.9 4.6 4.4 6.2

Sprains and strains of ankle and foot . . . . . . . . . . . . . . . . . . . . . 845 3.9 3.3 5.9 3.9 3.2 * 4.0 3.7 4.0 3.4

Open wound of other and unspecified sites, except limbs . . . . . . . . 879 3.7 5.3 3.4 3.0 3.5 * 3.8 3.6 3.6 3.8

Contusion of upper limb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 923 3.7 3.5 4.5 3.9 3.2 * 4.4 3.2 3.9 2.1

Contusion of face, scalp, and neck except eye(s) . . . . . . . . . . . . . 920 2.5 3.6 3.2 1.9 * * 3.0 2.2 2.5 2.4

Contusion of trunk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 922 2.2 1.4 3.0 2.4 * 2.5 2.5 1.9 2.2 2.1

Injury, other and unspecified . . . . . . . . . . . . . . . . . . . . . . . . . . 959 2.1 2.0 2.1 2.4 * * 2.2 2.0 2.0 2.6

Open wound of hand except finger(s) alone . . . . . . . . . . . . . . . . . 882 2.0 1.1 2.4 2.8 1.5 * 1.2 2.6 2.0 2.1

Intracranial injury of other and unspecified nature . . . . . . . . . . . . . 854 1.7 2.7 2.0 1.2 * * 1.5 1.8 1.6 1.9

Open wound of knee, leg (except thigh), and ankle . . . . . . . . . . . . 891 1.6 2.2 2.0 1.1 * * 1.2 1.9 1.6 1.6

Other and unspecified aftercare . . . . . . . . . . . . . . . . . . . . . . . . V58 1.6 2.2 1.7 1.2 * * 1.1 2.0 1.6 *

Fracture of radius and ulna . . . . . . . . . . . . . . . . . . . . . . . . . . . 813 1.5 3.6 * * * * 1.7 1.4 1.7 *

Sprains and strains of wrist and hand . . . . . . . . . . . . . . . . . . . . . 842 1.5 2.4 1.7 1.5 * * 1.7 1.4 1.7 *

Sprains and strains of knee and leg . . . . . . . . . . . . . . . . . . . . . . 844 1.5 * 2.2 2.0 * * 1.2 1.7 1.5 1.3

Fracture of one or more phalanges of hand . . . . . . . . . . . . . . . . . 816 1.4 2.1 1.5 1.1 * * 0.9 1.8 1.5 *

Superficial injury of eye and adnexa . . . . . . . . . . . . . . . . . . . . . 918 1.3 1.0 1.0 2.2 * * 1.5 1.2 1.4 *

Other and unspecified disorders of back . . . . . . . . . . . . . . . . . . . 724 1.2 * * 1.7 1.9 * 1.4 1.0 1.1 1.6

All other diagnoses ................................... 44.5 40.6 39.5 44.6 51.0 57.6 46.1 43.2 44.1 46.6

* Figure does not meet standard of reliability or precision.

1Based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM) (11).

2Estimates for races other than white and black have been omitted because of small sample sizes.

3A visit was considered to be injury related if ‘‘injury, first visit’’ or ‘‘injury, followup visit‘‘ was reported in item 9 of the Patient Record form, or if a cause of injury was reported in item 10 of the

Patient Record form.

NOTE: Numbers may not add to totals because of rounding.

31
Table 13. Number and percent distribution of injury-related emergency department visits by patient’s age, sex, and race, according to

the 20 most frequent principal diagnoses: United States, 1992

Principal diagnosis

and ICD–9–CM code1

Number of

visits in

thousands

Age Sex Race2

Total

Under

15 years

15–24

years

25–44

years

45–64

years

65 years

and over Female Male White Black

Percent distribution

All injury-related visits3 ............................ 33,950 100.0 25.7 20.4 33.2 11.7 9.0 43.6 56.4 82.9 14.7

Other open wound of head . . . . . . . . . . . . . . . . . . . . . . . 873 2,561 100.0 48.2 13.1 20.0 8.5 10.3 35.1 64.9 82.2 15.8

Confusion of lower limb and of other and unspecified sites . . . 924 1,755 100.0 21.5 20.2 35.2 14.4 8.6 51.2 48.8 80.1 18.3

Open wound of fingers . . . . . . . . . . . . . . . . . . . . . . . . . . 883 1,604 100.0 13.7 25.0 39.7 16.6 * 32.1 67.9 87.5 10.3

Sprains and strains of other and unspecified parts of back . . . . 847 1,597 100.0 4.8 28.8 49.8 9.0 7.5 45.2 54.8 77.2 19.5

Sprains and strains of ankle and foot . . . . . . . . . . . . . . . . . 845 1,311 100.0 22.0 31.2 33.8 9.6 * 45.7 54.3 85.3 13.0

Open wound of other and unspecified sites, except limbs . . . . 879 1,257 100.0 36.7 18.8 26.6 11.0 * 44.7 55.4 81.5 14.9

Contusion of upper limb . . . . . . . . . . . . . . . . . . . . . . . . . 923 1,255 100.0 24.1 24.9 34.9 10.2 * 51.6 48.4 88.3 8.2

Contusion of face, scalp, and neck except eye(s) . . . . . . . . . 920 863 100.0 36.1 26.1 24.7 * * 51.1 48.9 83.0 13.9

Contusion of trunk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 922 744 100.0 16.0 28.3 35.7 * 10.3 50.2 49.8 82.8 14.2

Injury, other and unspecified . . . . . . . . . . . . . . . . . . . . . . 959 720 100.0 24.5 20.4 38.1 * * 46.2 53.8 79.4 17.9

Open wound of hand except finger(s) alone . . . . . . . . . . . . . 882 675 100.0 14.2 25.2 46.7 9.0 * 25.8 74.2 82.6 15.6

Intracranial injury of other and unspecified nature . . . . . . . . . 854 564 100.0 41.4 24.0 23.4 * * 40.3 59.7 81.3 17.0

Open wound of knee, leg (except thigh), and ankle . . . . . . . . 891 548 100.0 35.1 25.9 22.9 * * 33.0 67.0 83.1 14.6

Other and unspecified aftercare . . . . . . . . . . . . . . . . . . . V58 540 100.0 35.4 21.6 25.6 * * 30.7 69.3 85.0 *

Fracture of radius and ulna . . . . . . . . . . . . . . . . . . . . . . . 813 518 100.0 60.9 * * * * 48.9 51.1 93.0 *

Sprains and strains of wrist and hand . . . . . . . . . . . . . . . . . 842 518 100.0 39.7 23.2 33.7 * * 47.6 52.4 91.1 *

Sprains and strains of knee and leg . . . . . . . . . . . . . . . . . . 844 509 100.0 * 29.4 43.3 * * 34.9 65.1 85.7 12.4

Fracture of one or more phalanges of hand . . . . . . . . . . . . . 816 482 100.0 38.7 21.5 25.6 * * 28.4 71.6 85.3 *

Superficial injury of eye and adnexa . . . . . . . . . . . . . . . . . 918 442 100.0 20.4 16.5 55.2 * * 49.5 50.5 90.5 *

Other and unspecified disorders of back . . . . . . . . . . . . . . . 724 392 100.0 * * 48.7 19.5 * 52.1 47.9 78.9 20.4

All other diagnoses .............................. 15,095 100.0 23.5 18.2 33.3 13.4 11.7 45.3 54.7 82.2 15.4

* Figure does not meet standard of reliability or precision.

1Based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM) (11).

2Estimates for races other than white and black have been omitted because of small sample sizes.

3A visit was considered to be injury related if ‘‘injury, first visit’’ or injury, followup visit‘‘ was reported in item 9 of the Patient Record form, or if a cause of injury was reported in item 10 of the

Patient Record form.

NOTE: Numbers may not add to totals because of rounding.

32
Table 14. Number and percent distribution of injury-related emergency department visits by principal cause of injury, according to

patient’s age, sex, and race: United States, 1992

Principal cause of injury

and E code1

All

ages

Age Sex Race2

Under 15

years

15–24

years

25–44

years

45–64

years

65 years

and over Female Male White Black

Number of visits in thousands

All injury-related visits3 ............................... 33,950 8,714 6,937 11,277 3,959 3,063 14,812 19,138 28,154 4,987

Accidental falls ............................ E880–E888 7,706 2,527 941 1,747 995 1,496 3,983 3,722 6,744 778

Other and unspecified falls ....................... E888 4,223 1,404 492 785 446 1,097 2,310 1,913 3,717 421

Fall on same level from slipping, tripping, or stumbling ...... E885 1,289 295 222 390 198 184 691 599 1,152 97

Other fall from one level to another .................. E884 987 524 * 162 111 134 455 531 869 107

Fall on or from stairs or steps ..................... E880 639 161 68 215 138 *56 396 243 534 89

Residual ...................... E881–E883,E886–E887 567 143 104 194 101 * 131 436 472 *

Motor vehicle accidents, traffic and nontraffic ......... E810–E825 4,130 529 1,243 1,555 493 311 1,984 2,147 3,191 802

Unspecified motor vehicle accident .................. E819 2,694 286 822 1,099 305 183 1,344 1,349 2,062 548

Other motor vehicle accident involving collision with another

motor vehicle .............................. E812 403 * 112 152 62 * 199 204 298 92

Other noncollision motor vehicle accident .............. E818 333 * 84 103 * * 160 173 234 *

Residual ............... E810–E811,E813–E817,E820–E825 701 143 224 201 * * 281 420 596 89

Accidents caused by cutting or piercing instruments or

objects .................................... E920 3,077 715 663 1,163 394 142 1,050 2,027 2,540 426

Striking against or struck accidentally by objects or

persons ................................... E917 3,018 1,032 751 841 267 127 1,048 1,970 2,557 406

Overexertion and strenuous movements ................ E927 1,587 185 364 750 242 * 676 911 1,314 244

Homicide and injury purposely inflicted by other

persons4 ............................... E960–E969 1,554 151 489 763 136 * 602 952 970 544

Assault by other or unspecified means ................ E968 731 * 234 385 * * 292 439 429 279

Fight, brawl, rape ............................. E960 588 69 199 265 * * 253 334 395 183

Assault by cutting and piercing instrument ............. E966 173 * * 108 * * * 149 94 73

Accidents due to natural and environmental factors4 .... E900–E909 1,374 527 198 415 144 91 739 635 1,177 194

Other injury caused by animals .................... E906 864 393 99 234 90 * 459 405 743 121

Venomous animals and plants ..................... E905 442 113 * 158 * * 238 204 376 62

Accidents caused by submersion, suffocation, and foreign

bodies4 ................................ E910–E915 1,040 334 141 423 88 *55 413 627 876 136

Foreign body accidentally entering eye and adnexa ........ E914 646 94 130 353 * * 213 433 578 57

Foreign body accidentally entering other orifice .......... E915 324 192 * 70 * * 160 163 241 74

Caught accidentally in or between objects ............... E918 670 219 131 201 * * 289 380 589 *55

Struck accidentally by falling object ................... E916 639 95 142 251 100 * 272 368 552 80

Other road vehicle accidents4 .................. E826–E829 638 424 105 86 * * 224 414 572 *

Pedal accident .............................. E826 547 390 * * * * 152 396 488 *

Accidents caused by machinery ..................... E919 488 * * 240 113 * 148 340 437 *

Accidents caused by hot substance or object, caustic or

corrosive material, and steam ...................... E924 473 136 106 186 * * 220 253 367 101

Surgical and medical procedures as the cause of abnormal

reaction of patient or later complication without mention of

misadventure at time of procedure ............... E878–E879 404 * * 176 64 88 216 188 291 *

Drugs, medicinal and biological substances causing adverse

effects in therapeutic use ..................... E930–E949 370 * * 128 * * 238 132 297 *

Accidental poisoning by drugs, medicinal substances, and

biologicals .............................. E850–E858 333 91 96 73 * * 204 130 256 *

Accidental poisoning by other solid and liquid substances,

gases, and vapors ......................... E860–E869 192 * * * * * * 123 163 *

Suicide and self-inflicted injury .................. E950–E959 160 * * * * * * * 143 *

Accidents caused by fire and flames .............. E890–E899 127 * * * * * * 84 112 *

Other5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 617 125 139 271 * * 219 398 490 110

Unknown6 ....................................... 5,351 1,391 1,124 1,805 592 440 2,086 3,265 4,517 757

Percent distribution

All injury-related visits3 ............................... 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Accidental falls ............................ E880–E888 22.7 29.0 13.6 15.5 25.1 48.8 26.9 19.5 24.0 15.6

Other and unspecified falls ....................... E888 12.4 16.1 7.1 7.0 11.3 35.8 15.6 10.0 13.2 8.4

Fall on same level from slipping, tripping, or stumbling ...... E885 3.8 3.4 3.2 3.5 5.0 6.0 4.7 3.1 4.1 2.0

Other fall from one level to another .................. E884 2.9 6.0 * 1.4 2.8 4.4 3.1 2.8 3.1 2.2

Fall on or from stairs or steps ..................... E880 1.9 1.9 1.0 1.9 3.5 *1.8 2.7 1.3 1.9 1.8

Residual ...................... E881–E883,E886–E887 1.7 1.6 1.5 1.7 2.6 * 0.9 2.3 1.7 *

33
Table 14. Number and percent distribution of injury-related emergency department visits by principal cause of injury, according to

patient’s age, sex, and race: United States, 1992—Con.

Principal cause of injury

and E code1

All

ages

Age Sex Race2

Under 15

years

15–24

years

25–44

years

45–64

years

65 years

and over Female Male White Black

Percent distribution

Motor vehicle accidents, traffic and nontraffic ......... E810–E825 12.2 6.1 17.9 13.8 12.5 10.2 13.4 11.2 11.3 16.1

Unspecified motor vehicle accident .................. E819 7.9 3.3 11.8 9.7 7.7 6.0 9.1 7.0 7.3 11.0

Other motor vehicle accident involving collision with another

motor vehicle .............................. E812 1.2 * 1.6 1.3 1.6 * 1.3 1.1 1.1 1.9

Other noncollision motor vehicle accident .............. E818 1.0 * 1.2 0.9 * * 1.1 0.9 0.8 *

Residual ............... E810–E811,E813–E817,E820–E825 2.1 1.6 3.2 1.8 * * 1.9 2.2 2.1 1.8

Accidents caused by cutting or piercing instruments or

objects .................................... E920 9.1 8.2 9.6 10.3 9.9 4.6 7.1 10.6 9.0 8.5

Striking against or struck accidentally by objects or persons .... E917 8.9 11.8 10.8 7.5 6.7 4.1 7.1 10.3 9.1 8.1

Overexertion and strenuous movements ................ E927 4.7 2.1 5.2 6.7 6.1 * 4.6 4.8 4.7 4.9

Homicide and injury purposely inflicted by other

persons4 ............................... E960–E969 4.6 1.7 7.1 6.8 3.4 * 4.1 5.0 3.4 10.9

Assault by other and unspecified means .............. E968 2.2 * 3.4 3.4 * * 2.0 2.3 1.5 5.6

Fight, brawl, rape ............................. E960 1.7 0.8 2.9 2.3 * * 1.7 1.7 1.4 3.7

Assault by cutting or piercing instrument .............. E966 0.5 * * 1.0 * * * 0.8 0.3 1.5

Accidents due to natural and environmental factors4 .... E900–E909 4.0 6.0 2.8 3.7 3.6 3.0 5.0 3.3 4.2 3.9

Other injury caused by animals .................... E906 2.5 4.5 1.4 2.1 2.3 * 3.1 2.1 2.6 2.4

Venomous animals and plants ..................... E905 1.3 1.3 * 1.4 * * 1.6 1.1 1.3 1.2

Accidents caused by submersion, suffocation, and foreign

bodies4 ................................ E910–E915 3.1 3.8 2.0 3.7 2.2 *1.8 2.8 3.3 3.1 2.7

Foreign body accidentally entering eye and adnexa ........ E914 1.9 1.1 1.9 3.1 * * 1.4 2.3 2.1 1.1

Foreign body accidentally entering other orifice .......... E915 1.0 2.2 * 0.6 * * 1.1 0.9 0.9 1.5

Caught accidentally in or between objects ............... E918 2.0 2.5 1.9 1.8 * * 2.0 2.0 2.1 *1.1

Struck accidentally by falling object ................... E916 1.9 1.1 2.0 2.2 2.5 * 1.8 1.9 2.0 1.6

Other road vehicle accidents4 .................. E826–E829 1.9 4.9 1.5 0.8 * * 1.5 2.2 2.0 *

Pedal accident .............................. E826 1.6 4.5 * * * * 1.0 2.1 1.7 *

Accidents caused by machinery ..................... E919 1.4 * * 2.1 2.8 * 1.0 1.8 1.6 *

Accidents caused by hot substance or object, caustic or

corrosive material, and steam ...................... E924 1.4 1.6 1.5 1.7 *0.9 *0.3 1.5 1.3 1.3 2.0

Surgical and medical procedures as the cause of abnormal reaction

of patient or later complication without mention of misadventure at

time of procedure ......................... E878–E879 1.2 *0.5 *0.5 1.6 1.6 2.9 1.5 1.0 1.0 *

Drugs, medicinal and biological substances causing adverse effects

in therapeutic use ......................... E930–E949 1.1 0.9 *0.7 1.1 *1.4 2.0 1.6 0.7 1.1 *

Accidental poisoning by drugs, medicinal substances, and

biologicals .............................. E850–E858 1.0 1.0 1.4 0.7 *0.9 *1.2 1.4 0.7 0.9 *

Accidental poisoning by other solid and liquid substances,

gases, and vapors ......................... E860–E869 0.6 * * * * * * 0.6 0.6 *

Suicide and self-inflicted injury .................. E950–E959 0.5 * * * * * * * 0.5 *

Accidents caused by fire and flames .............. E890–E899 0.4 * * * * * * 0.4 0.4 *

Other5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.8 1.4 2.0 2.4 * * 1.5 2.1 1.7 2.2

Unknown6 ....................................... 15.8 16.0 16.2 16.0 15.0 14.4 14.1 17.1 16.0 15.2

* Figure does not meet standard of reliability or precision.

1Based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM) (11).

2Estimates for races other than white and black have been omitted because of small sample sizes.

3For the purposes of this table, visits were considered to be injury related if ‘‘injury, first visit’’ or ‘‘injury, followup visit’’ was checked in item 9 of the Patient Record form, or if a cause of injury was

reported in item 10 of the Patient Record form.

4Residual category not shown because of small sample sizes.

5Includes railway accidents (E800–E807), water transport accidents (E830–E838), air and space transport accidents (E840–E845), vehicle accidents not elsewhere classifiable (E846–E848),

misadventures to patients during surgical and medical care (E870–E876), accident caused by explosion of pressure vessel (E921), accident caused by firearm missile (E922), accident caused by

explosive material (E923), accident caused by electric current (E925), exposure to radiation (E926), other and unspecified environmental and accidental causes (E928), late effects of accidental

injury (E929), legal intervention (E970–E978), injury undetermined whether accidentally or purposely inflicted (E980–E989), and injury resulting from operations of war (E990–E999).

6Includes uncodable, illegible, and blank entries.

NOTE: Numbers may not add to totals because of rounding.

34
Table 15. Number and percent distribution of injury-related emergency department visits by patient’s age, sex, and race, according to

principal cause of injury: United States, 1992

Principal cause of injury and E code1

Number of

visits in

thousands

Age Sex Race2

Total

Under

15 years

15–24

years

25–44

years

45–64

years

65 years

and over Female Male White Black

Percent distribution

All injury-related visits3 ............................... 33,950 100.0 25.7 20.4 33.2 11.7 9.0 43.6 56.4 82.9 14.7

Accidental falls ............................ E880–E888 7,706 100.0 32.8 12.2 22.7 12.9 19.4 51.7 48.3 87.5 10.1

Other and unspecified falls ....................... E888 4,223 100.0 33.2 11.6 18.6 10.6 26.0 54.7 45.3 88.0 10.0

Fall on same level from slipping, tripping, or stumbling ...... E885 1,289 100.0 22.9 17.2 30.3 15.3 14.3 53.6 46.4 89.3 7.6

Other fall from one level to another .................. E884 987 100.0 53.1 * 16.4 11.2 13.6 46.1 53.9 88.1 10.9

Fall on or from stairs or steps ..................... E880 639 100.0 25.2 10.7 33.6 21.6 8.8 61.9 38.1 83.5 13.9

Residual ...................... E881–E883,E886–E887 567 100.0 25.3 18.3 34.3 17.9 * 23.1 76.9 83.2 *

Motor vehicle accidents, traffic and nontraffic ......... E810–E825 4,130 100.0 12.8 30.1 37.6 11.9 7.5 48.0 52.0 77.2 19.4

Unspecified motor vehicle accident .................. E819 2,694 100.0 10.6 30.5 40.8 11.3 6.8 49.9 50.1 76.5 20.3

Other motor vehicle accident involving collision

with another motor vehicle ...................... E812 403 100.0 * 27.9 37.6 15.4 * 49.4 50.6 73.8 22.9

Other noncollision motor vehicle accident .............. E818 333 100.0 * 25.4 31.1 * * 48.0 52.0 70.5 *

Residual ............... E810–E811,E813–E817,E820–E825 701 100.0 * 31.9 28.6 * * 40.1 59.9 85.1 12.7

Accidents caused by cutting or piercing instruments or

objects .................................... E920 3,077 100.0 23.2 21.6 37.8 12.8 4.6 34.1 65.9 82.6 13.8

Striking against or struck accidentally by objects or persons .... E917 3,018 100.0 34.2 24.9 27.9 8.9 4.2 34.7 65.3 84.7 13.5

Overexertion and strenuous movements ................ E927 1,587 100.0 11.7 22.9 47.3 15.3 * 42.6 57.4 82.8 15.4

Homicide and injury purposely inflicted by other

persons4 ............................... E960–E969 1,554 100.0 9.7 31.5 49.1 8.7 * 38.7 61.2 62.4 35.0

Assault by other and unspecified means .............. E968 731 100.0 * 32.0 52.6 * * 39.9 60.1 58.7 38.2

Fight, brawl, rape ............................. E960 588 100.0 11.7 33.9 45.1 * * 43.1 56.9 67.1 31.1

Assault by cutting or piercing instrument .............. E966 173 100.0 * * 62.6 * * * 86.0 54.2 42.2

Accidents due to natural and environmental factors4 .... E900–E909 1,374 100.0 38.4 14.4 30.2 10.4 6.6 53.8 46.2 85.6 14.1

Other injury caused by animals .................... E906 864 100.0 45.4 11.4 27.0 10.4 * 53.2 46.8 86.0 14.0

Venomous animals and plants ..................... E905 442 100.0 25.5 * 35.8 * * 53.8 46.2 85.1 14.1

Accidents caused by submersion, suffocation, and

foreign bodies4 ........................... E910–E915 1,040 100.0 32.1 13.5 40.6 8.4 5.3 39.7 60.3 84.2 13.1

Foreign body accidentally entering eye and adnexa ........ E914 646 100.0 14.5 20.2 54.6 * * 33.0 67.1 89.4 8.8

Foreign body accidentally entering other orifice .......... E915 324 100.0 59.5 * 21.6 * * 49.5 50.5 74.6 22.9

Caught accidentally in or between objects ............... E918 670 100.0 32.7 19.5 30.0 * * 43.2 56.8 87.9 8.3

Struck accidentally by falling object ................... E916 639 100.0 14.8 22.2 39.2 15.7 * 42.5 57.5 86.3 12.6

Other road vehicle accidents4 .................. E826–E829 638 100.0 66.4 16.4 13.5 * * 35.1 64.9 89.7 *

Pedal accident .............................. E826 547 100.0 71.2 * * * * 27.7 72.3 89.2 *

Accidents caused by machinery ..................... E919 488 100.0 * * 49.2 23.1 * 30.2 69.8 89.6 *

Accidents caused by hot substance or object, caustic or

corrosive material, and steam ...................... E924 473 100.0 28.7 22.4 39.4 * * 46.6 53.4 77.5 21.3

Surgical and medical procedures as the cause of abnormal reaction

of patient or later complication without mention of misadventure at

time of procedure ......................... E878–E879 404 100.0 * * 43.6 15.9 21.8 53.4 46.6 72.1 *

Drugs, medicinal and biological substances causing

adverse effects in therapeutic use ............... E930–E949 370 100.0 * * 34.5 * * 64.3 35.7 80.3 *

Accidental poisoning by drugs, medicinal substances, and

biologicals .............................. E850–E858 333 100.0 27.4 28.6 22.0 * * 61.1 38.9 76.8 *

Accidental poisoning by other solid and liquid substances,

gases, and vapors ......................... E860–E869 192 100.0 * * * * * * 64.1 84.8 *

Suicide and self-inflicted injury .................. E950–E959 160 100.0 * * * * * * * 89.5 *

Accidents caused by fire and flames .............. E890–E899 127 100.0 * * * * * * 66.2 87.8 *

Other5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 617 100.0 20.2 22.4 43.8 * * 35.5 64.5 79.4 17.9

Unknown6 ....................................... 5,351 100.0 26.0 21.0 33.7 11.1 8.2 39.0 61.0 84.4 14.1

* Figure does not meet standard of reliability or precision.

1Based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM) (11).

2Estimates for races other than white and black have been omitted because of small sample sizes.

3For the purposes of this table, visits were considered to be injury related if ‘‘injury, first visit’’ or ‘‘injury, followup visit’’ was checked in item 9 of the Patient Record form, or if a cause of injury was

reported in item 10 of the Patient Record form.

4Residual category not shown because of small sample sizes.

5Includes railway accidents (E800–E807), water transport accidents (E830–E838), air and space transport accidents (E840–E845), vehicle accidents not elsewhere classifiable (E846–E848),

misadventures to patients during surgical and medical care (E870–E876), accident caused by explosion of pressure vessel (E921), accident caused by firearm missile (E922), accident caused by

explosive material (E923), accident caused by electric current (E925), exposure to radiation (E926), other and unspecified environmental and accidental causes (E928), late effects of accidental

injury (E929), legal intervention (E970–E978), injury undetermined whether accidentally or purposely inflicted (E980–E989), and injury resulting from operations of war (E990–E999).

6Includes uncodable, illegible, and blank entries.

NOTE: Numbers may not add to totals because of rounding.

35
Table 16. Number, percent distribution, and annual rate of injury-related emergency department visits by patient’s age, sex, race, and

most frequent principal causes of injury: United States, 1992

Selected patient characteristic,

principal cause of injury, and E code1

Number of

visits in

thousands

Percent

distribution

Number of

visits per

1,000 persons

per year2

Age

All ages:

All injury-related visits3 ........................................... 33,950 100.0 135.0

Accidental falls ....................................... E880–E888 7,706 22.7 30.6

Motor vehicle accidents, traffic and nontraffic .................... E810–E825 4,130 12.2 16.4

Accidents caused by cutting or piercing instruments or objects ............. E920 3,077 9.1 12.2

Striking against or struck accidentally by objects or persons ............... E917 3,018 8.9 12.0

Overexertion and strenuous movements ........................... E927 1,587 4.7 6.3

Homicide and injury purposely inflicted by other persons ............. E960–E969 1,554 4.6 6.2

Accidents due to natural and environmental factors ................ E900–E909 1,374 4.0 5.5

Accidents caused by submersion, suffocation, and foreign bodies ....... E910–E915 1,040 3.1 4.1

Caught accidentally in or between objects .......................... E918 670 2.0 2.7

Struck accidentally by falling object .............................. E916 639 1.9 2.5

All other causes .............................................. 9,154 27.0 36.4

Under 15 years:

All injury-related visits3 ........................................... 8,714 100.0 154.4

Accidental falls ....................................... E880–E888 2,527 29.0 44.8

Striking against or struck accidentally by objects or persons ............... E917 1,032 11.8 18.3

Accidents caused by cutting or piercing instruments or objects ............. E920 715 8.2 12.7

Motor vehicle accidents, traffic and nontraffic .................... E810–E825 529 6.1 9.4

Accidents due to natural and environmental factors ................ E900–E909 527 6.0 9.3

Other road vehicle accidents .............................. E826–E829 424 4.9 7.5

Accidents caused by submersion, suffocation, and foreign bodies ....... E910–E915 334 3.8 5.9

Caught accidentally in or between objects .......................... E918 219 2.5 3.9

Overexertion and strenuous movements ........................... E927 185 2.1 3.3

Homicide and injury purposely inflicted by other persons ............. E960–E969 151 1.7 2.7

All other causes .............................................. 2,071 23.8 36.7

15–24 years:

All injury-related visits3 ........................................... 6,937 100.0 201.7

Motor vehicle accidents, traffic and nontraffic .................... E810–E825 1,243 17.9 36.1

Accidental falls ....................................... E880–E888 941 13.6 27.4

Striking against or struck accidentally by objects or persons ............... E917 751 10.8 21.8

Accidents caused by cutting or piercing instruments or objects ............. E920 663 9.6 19.3

Homicide and injury purposely inflicted by other persons ............. E960–E969 489 7.1 14.2

Overexertion and strenuous movements ........................... E927 364 5.2 10.6

Accidents due to natural and environmental factors ................ E900–E909 198 2.8 5.7

Accidents caused by submersion, suffocation, and foreign bodies ....... E910–E915 142 2.0 4.1

Struck accidentally by falling object .............................. E916 141 2.0 4.1

Caught accidentally in or between objects .......................... E918 131 1.9 3.8

All other causes .............................................. 1,875 27.0 54.5

25–44 years:

All injury-related visits3 ........................................... 11,277 100.0 138.7

Accidental falls ....................................... E880–E888 1,747 15.5 21.5

Motor vehicle accidents, traffic and nontraffic .................... E810–E825 1,555 13.8 19.1

Accidents caused by cutting or piercing instruments or objects ............. E920 1,163 10.3 14.3

Striking against or struck accidentally by objects or persons ............... E917 841 7.5 10.3

Homicide and injury purposely inflicted by other persons ............. E960–E969 763 6.8 9.4

Overexertion and strenuous movements ........................... E927 750 6.7 9.2

Accidents caused by submersion, suffocation, and foreign bodies ....... E910–E915 423 3.7 5.2

Accidents due to natural and environmental factors ................ E900–E909 415 3.7 5.1

Struck accidentally by falling object .............................. E916 251 2.2 3.1

Accidents caused by machinery ................................ E919 240 2.1 3.0

Caught accidentally in or between objects .......................... E918 201 1.8 2.5

All other causes .............................................. 2,929 26.0 36.0

45–64 years:

All injury-related visits3 ........................................... 3,959 100.0 81.6

Accidental falls ....................................... E880–E888 995 25.1 20.5

Motor vehicle accidents, traffic and nontraffic .................... E810–E825 493 12.5 10.2

Accidents caused by cutting or piercing instruments or objects ............. E920 394 9.9 8.1

Striking against or struck accidentally by objects or persons ............... E917 267 6.7 5.5

Overexertion and strenuous movements ........................... E927 242 6.1 5.0

Accidents due to natural and environmental factors ................ E900–E909 144 3.6 3.0

Homicide and injury purposely inflicted by other persons ............. E960–E969 136 3.4 2.8

36
Table 16. Number, percent distribution, and annual rate of injury-related emergency department visits by patient’s age, sex, race, and

most frequent principal causes of injury: United States, 1992—Con.

Selected patient characteristic,

principal cause of injury, and E code1

Number of

visits in

thousands

Percent

distribution

Number of

visits per

1,000 persons

per year2

45–64 years:—Con.

Accidents caused by machinery ................................ E919 113 2.9 2.3

Struck accidentally by falling object .............................. E916 100 2.5 2.1

All other causes .............................................. 1,075 27.2 22.2

65 years and over:

All injury-related visits3 ........................................... 3,063 100.0 99.5

Accidental falls ....................................... E880–E888 1,496 48.8 48.6

Motor vehicle accidents, traffic and nontraffic .................... E810–E825 311 10.2 10.1

Accidents caused by cutting or piercing instruments or objects ............. E920 142 4.6 4.6

Striking against or struck accidentally by objects or persons ............... E917 127 4.1 4.1

Accidents due to natural and environmental factors ................ E900–E909 91 3.0 3.0

Surgical and medical procedures as the cause of abnormal reaction of patient or later

complication without mention of misadventure at time of procedure ...... E878–E879 88 2.9 2.9

All other causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 808 26.4 26.3

Sex

Female:

All injury-related visits3 ........................................... 14,812 100.0 114.6

Accidental falls ....................................... E880–E888 3,983 26.9 30.8

Motor vehicle accidents, traffic and nontraffic .................... E810–E825 1,984 13.4 15.3

Accidents caused by cutting or piercing instruments or objects ............. E920 1,050 7.1 8.1

Striking against or struck accidentally by objects or persons ............... E917 1,048 7.1 8.1

Accidents due to natural and environmental factors ................ E900–E909 739 5.0 5.7

Overexertion and strenuous movements ........................... E927 676 4.6 5.2

Homicide and injury purposely inflicted by other persons ............. E960–E969 602 4.1 4.7

Accidents caused by submersion, suffocation, and foreign bodies ....... E910–E915 413 2.8 3.2

Caught accidentally in or between objects .......................... E918 289 2.0 2.2

Struck accidentally by falling object .............................. E916 272 1.8 2.1

All other causes .............................................. 3,756 25.4 29.1

Male:

All injury-related visits3 ........................................... 19,138 100.0 156.6

Accidental falls ....................................... E880–E888 3,722 19.5 30.5

Motor vehicle accidents, traffic and nontraffic .................... E810–E825 2,147 11.2 17.6

Accidents caused by cutting or piercing instruments or objects ............. E920 2,027 10.6 16.6

Striking against or struck accidentally by objects or persons ............... E917 1,970 10.3 16.1

Homicide and injury purposely inflicted by other persons ............. E960–E969 952 5.0 7.8

Overexertion and strenuous movements ........................... E927 911 4.8 7.5

Accidents due to natural and environmental factors ................ E900–E909 635 3.3 5.2

Accidents caused by submersion, suffocation, and foreign bodies ....... E910–E915 627 3.3 5.1

Other road vehicle accidents .............................. E826–E829 414 2.2 3.4

Caught accidentally in or between objects .......................... E918 380 2.0 3.1

All other causes .............................................. 5,352 28.0 43.8

Race4

White:

All injury-related visits3 ........................................... 28,154 100.0 134.4

Accidental falls ....................................... E880–E888 6,744 24.0 32.2

Motor vehicle accidents, traffic and nontraffic .................... E810–E825 3,191 11.3 15.2

Striking against or struck accidentally by objects or persons ............... E917 2,557 9.1 12.2

Accidents caused by cutting or piercing instruments or objects ............. E920 2,540 9.0 12.1

Overexertion and strenuous movements ........................... E927 1,314 4.7 6.3

Accidents due to natural and environmental factors ................ E900–E909 1,177 4.2 5.6

Homicide and injury purposely inflicted by other persons ............. E960–E969 970 3.4 4.6

Accidents caused by submersion, suffocation, and foreign bodies ....... E910–E915 876 3.1 4.2

Caught accidentally in or between objects .......................... E918 589 2.1 2.8

Struck accidentally by falling object .............................. E916 552 2.0 2.6

All other causes .............................................. 7,644 27.2 36.5

37
Table 16. Number, percent distribution, and annual rate of injury-related emergency department visits by patient’s age, sex, race, and

most frequent principal causes of injury: United States, 1992—Con.

Selected patient characteristic,

principal cause of injury, and E code1

Number of

visits in

thousands

Percent

distribution

Number of

visits per

1,000 persons

per year2

Race4—Con.

Black:

All injury-related visits3 ........................................... 4,987 100.0 158.5

Motor vehicle accidents, traffic and nontraffic .................... E810–E825 802 16.1 25.5

Accidental falls ....................................... E880–E888 778 15.6 24.7

Homicide and injury purposely inflicted by other persons ............. E960–E969 544 10.9 17.3

Accidents caused by cutting or piercing instruments or objects ............. E920 426 8.5 13.5

Striking against or struck accidentally by objects or persons ............... E917 406 8.1 12.9

Overexertion and strenuous movements ........................... E927 244 4.9 7.8

Accidents due to natural and environmental factors ................ E900–E909 194 3.9 6.2

Accidents caused by submersion, suffocation, and foreign bodies ....... E910–E915 136 2.7 4.3

Accidents caused by hot substance or object, caustic or corrosive material,

and steam ............................................. E924 101 2.0 3.2

All other causes .............................................. 1,356 27.2 43.1

1Based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM) (11).

2Based on U.S. Bureau of the Census estimates of the civilian noninstitutionalized population of the United States as of July 1, 1992.

3For the purposes of this table, visits were considered to be injury related if ‘‘injury, first visit’’ or ‘‘injury, followup visit’’ was checked in item 9 of the Patient Record form, or if a cause of injury was

reported in item 10 of the Patient Record form.

4Estimates for races other than white and black have been omitted because of small sample sizes.

NOTE: Numbers may not add to totals because of rounding.

38
Table 17. Number, percent distribution, and annual rate of alcohol- and/or drug-related emergency department visits by patient’s age,

sex, and race: United States, 1992

Patient characteristic

Number of

visits in

thousands

Percent

distribution

Number of

visits per

1,000 persons

per year1

All alcohol- and/or drug-related visits2 ................................... 4,122 100.0 16.4

Age

Under 15 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306 7.4 5.4

15–24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 677 16.4 19.7

25–44 years ................................................... 2,184 53.0 26.9

45–64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 722 17.5 14.9

65 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234 5.7 7.6

Sex and age

Female ...................................................... 1,627 39.5 12.6

Under 15 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 3.6 5.4

15–24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299 7.3 17.3

25–44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 766 18.6 18.5

45–64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 316 7.7 12.5

65 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 2.4 5.4

Male ........................................................ 2,495 60.5 20.4

Under 15 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 3.8 5.4

15–24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378 9.2 22.1

25–44 years .................................................. 1418 34.4 35.5

45–64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406 9.8 17.4

65 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 3.3 10.5

Race and age

White ....................................................... 3,060 74.2 14.6

Under 15 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252 6.1 5.6

15–24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 557 13.5 20.3

25–44 years .................................................. 1,517 36.8 22.4

45–64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 533 12.9 12.8

65 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201 4.9 7.3

Black 933 22.6 29.7

Under 15 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *39 *0.9 *4.4

15–24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 2.4 19.0

25–44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 591 14.3 60.3

45–64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 4.2 34.7

65 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *33 *0.8 *12.6

All other races . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 3.2 12.4

* Figure does not meet standard of reliability or precision.

1Based on U.S. Bureau of the Census estimates of the civilian noninstitutionalized population of the United States as of July 1, 1992.

2Visits were considered to be alcohol or drug related if ‘‘alcohol related,’’ ‘‘drug related,’’ or ‘‘both’’ was reported in item 14 of the Patient Record form or if an alcohol-related diagnosis was reported

in item 12. A list of diagnoses used in this analysis is available (4).

NOTE: Numbers may not add to totals because of rounding.

39
Table 18. Number and percent of emergency department visits by diagnostic and screening services ordered or provided, and patient’s

age, sex, and race: United States, 1992

Diagnostic or screening service

ordered or provided

Age Sex Race2

All

ages

Under

15 years

15–24

years

25–44

years

45–64

years

65–74

years

75 years

and over Female Male White Black

Number of visits in thousands1

All visits ............................ 89,796 22,523 14,848 27,240 12,509 5,806 6,871 46,612 43,184 70,478 17,150

None .............................. 10,861 6,345 1,204 2,105 757 235 216 5,130 5,731 8,370 2,289

Blood pressure check ................... 66,177 10,544 11,874 22,357 10,479 4,928 5,995 35,001 31,176 51,935 12,550

Urinalysis ........................... 13,620 1,776 2,756 4,090 2,132 1,107 1,759 8,524 5,096 10,561 2,728

HIV serology3 . . . . . . . . . . . . . . . . . . . . . . . . 270 * * 120 * * * 124 147 172 *

Other blood test ....................... 25,812 3,156 3,645 6,951 4,932 3,050 4,077 14,853 10,959 20,773 4,456

EKG4 ............................. 11,886 242 544 2,577 3,058 2,331 3,134 6,407 5,479 10,013 1,633

Mental status exam ..................... 5,276 1,257 754 1,495 789 430 551 2,664 2,613 3,956 1,222

Chest x ray .......................... 15,081 2,162 1,119 3,308 3,240 2,185 3,067 7,974 7,107 12,228 2,511

Extremity x ray ........................ 13,539 2,953 2,763 4,397 1,828 791 807 6,318 7,221 11,306 1,910

CT scan/MRI5 ........................ 2,161 234 303 557 424 283 361 936 1,226 1,789 319

Other diagnostic imaging ................. 9,363 1,191 1,580 3,112 1,656 743 1,083 5,001 4,362 7,579 1,563

Other .............................. 17,725 4,611 3,100 5,133 2,183 1,302 1,396 10,005 7,720 14,099 3,236

Percent

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... ... ... ... ... ... ... ... ... ... ...

None .............................. 12.1 28.2 8.1 7.7 6.0 4.0 3.1 11.0 13.3 11.9 13.3

Blood pressure check ................... 73.7 46.8 80.0 82.1 83.8 84.9 87.3 75.1 72.2 73.7 73.2

Urinalysis ........................... 15.2 7.9 18.6 15.0 17.0 19.1 25.6 18.3 11.8 15.0 15.9

HIV serology3 . . . . . . . . . . . . . . . . . . . . . . . . 0.3 * * 0.4 * * * 0.3 0.3 0.2 *

Other blood test ....................... 28.7 14.0 24.6 25.5 39.4 52.5 59.3 31.9 25.4 29.5 26.0

EKG4 ............................. 13.2 1.1 3.7 9.5 24.4 40.2 45.6 13.7 12.7 14.2 9.5

Mental status exam . . . . . . . . . . . . . . . . . . . . . 5.9 5.6 5.1 5.5 6.3 7.4 8.0 5.7 6.0 5.6 7.1

Chest x ray .......................... 16.8 9.6 7.5 12.1 25.9 37.6 44.6 17.1 16.5 17.4 14.6

Extremity x ray ........................ 15.1 13.1 18.6 16.1 14.6 13.6 11.8 13.6 16.7 16.0 11.1

CT scan/MRI5 . . . . . . . . . . . . . . . . . . . . . . . . 2.4 1.0 2.0 2.0 3.4 4.9 5.3 2.0 2.8 2.5 1.9

Other diagnostic imaging ................. 10.4 5.3 10.6 11.4 13.2 12.8 15.8 10.7 10.1 10.8 9.1

Other .............................. 19.7 20.5 20.9 18.8 17.4 22.4 20.3 21.5 17.9 20.0 18.9

* Figure does not meet standard of reliability or precision.

. . . Category not applicable.

1Numbers may not add to totals because more than one diagnostic or screening service may be reported per visit.

2Estimates for races other than white and black have been omitted because of small sample sizes.

3HIV is human immunodeficiency virus.

4EKG is electrocardiogram.

5CT scan is computerized tomography scan and MRI is magnetic resonance imaging.

NOTE: Example of use of table: Electrocardiograms were ordered or provided at 45.6 percent of all visits by persons 75 years and over.

40
Table 19. Number and percent distribution of emergency department visits by selected diagnostic and screening services ordered or

provided, and most frequent principal reasons for visit: United States, 1992

Diagnostic or screening service,

principal reason for visit, and RVC code1

Number of

visits in

thousands

Percent

distribution

Percent of

visits service

was ordered

or provided

Chest x ray, all reasons .......................................... 15,081 100.0 16.8

Chest pain and related symptoms .............................. S050 3,120 20.7 67.5

Shortness of breath ....................................... S415 1,336 8.9 65.9

Fever ................................................ S010 834 5.5 22.7

Labored or difficult breathing .................................. S420 757 5.0 61.1

Cough ................................................ S440 697 4.6 34.9

Stomach and abdominal pain, cramps, and spasms ................... S545 661 4.4 13.3

Pain, site not referable to a specific body system ..................... S055 485 3.2 26.8

Vomiting .............................................. S530 329 2.2 17.5

General weakness ........................................ S020 298 2.0 49.6

Back symptoms .......................................... S905 294 2.0 15.0

Unconscious on arrival ..................................... J840 238 1.6 37.8

Vertigo-dizziness ......................................... S225 227 1.5 21.3

Headache, pain in head ..................................... S210 223 1.5 8.7

Asthma ............................................... D625 201 1.3 32.8

Nausea ............................................... S525 193 1.3 21.3

All other reasons ............................................. 5,189 34.3 8.8

Extremity x ray, all reasons ........................................ 13,539 100.0 15.1

Hand and finger symptoms ................................... S960 968 7.1 69.6

Knee symptoms .......................................... S925 784 5.8 71.1

Hand and finger(s) injury, type unspecified ......................... J570 780 5.8 78.4

Ankle symptoms ......................................... S930 737 5.4 82.8

Foot and toe symptoms ..................................... S935 673 5.0 62.0

Wrist symptoms .......................................... S955 544 4.0 82.4

Leg symptoms .......................................... S920 498 3.7 43.2

Arm symptoms .......................................... S945 472 3.5 54.3

Shoulder symptoms ....................................... S940 458 3.4 49.6

Lacerations and cuts of upper extremity ........................... J225 433 3.2 18.4

Foot and toe(s) injury, type unspecified ........................... J545 370 2.7 85.4

Ankle injury, type unspecified ................................. J540 353 2.6 80.7

Arm injury, type unspecified .................................. J555 303 2.2 85.2

Hip symptoms ........................................... S915 285 2.1 57.3

All other reasons ............................................. 5,882 43.5 7.7

Electrocardiogram, all reasons ...................................... 11,886 100.0 13.2

Chest pain and related symptoms .............................. S050 3,471 29.2 75.0

Shortness of breath ....................................... S415 1,049 8.8 51.8

Stomach and abdominal pain, cramps, and spasms ................... S545 641 5.4 12.9

Labored or difficult breathing .................................. S420 468 3.9 37.8

Vertigo-dizziness ......................................... S225 454 3.8 42.6

Abnormal pulsations and palpitations ............................. S260 389 3.3 77.9

Unconscious on arrival ..................................... J840 317 2.7 50.2

General weakness ........................................ S020 290 2.4 48.3

Fainting (syncope) ........................................ S030 261 2.2 53.5

Vomiting .............................................. S530 243 2.0 12.9

Fever ................................................ S010 181 1.5 4.9

Headache, pain in head ..................................... S210 169 1.4 6.6

Nausea ............................................... S525 168 1.4 18.5

Convulsions ............................................ S205 149 1.3 18.7

Back symptoms .......................................... S905 142 1.2 7.2

All other reasons ............................................. 3,496 29.5 5.6

Mental status exam, all reasons ..................................... 5,276 100.0 5.9

Headache, pain in head ..................................... S210 268 5.1 10.5

Fever ................................................ S010 255 4.8 6.9

Chest pain and related symptoms .............................. S050 205 3.9 4.4

Stomach and abdominal pain, cramps, and spasms ................... S545 187 3.6 3.8

Convulsions ............................................ S205 171 3.2 21.5

Unconscious on arrival ..................................... J840 164 3.1 26.0

Shortness of breath ....................................... S415 135 2.6 6.7

Other symptoms or problems relating to psychological or mental disorders

not elsewhere classified .................................... S165 133 2.5 34.1

Lacerations and cuts of facial area .............................. J210 128 2.4 8.6

Head, neck, and face injury, type unspecified ....................... J505 121 2.3 11.3

All other reasons ............................................. 3,509 66.5 5.2

1Based on A Reason for Visit Classification for Ambulatory Care (RVC) (10).

41
Table 20. Number, percent distribution, and annual rate of emergency department visits by the 60 most frequent principal diagnoses:

United States, 1992

Rank Principal diagnosis and ICD–9–CM code1

Number of

visits in

thousands

Percent

distribution

Number of visits

per 1,000 persons

per year2

. . . All visits ............................................... 89,796 100.0 357.1

1 Suppurative and unspecified otitis media . . . . . . . . . . . . . . . . . . . . . . . . 382 3,162 3.5 12.6

2 Symptoms involving respiratory system and other chest symptoms . . . . . . . 786 2,667 3.0 10.6

3 Other open wound of head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 873 2,578 2.9 10.3

4 Other symptoms involving abdomen and pelvis . . . . . . . . . . . . . . . . . . . . 789 2,353 2.6 9.4

5 General symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 780 2,340 2.6 9.3

6 Acute upper respiratory infections of multiple or unspecified sites . . . . . . . . 465 1,998 2.2 7.9

7 Sprains and strains of other and unspecified parts of back . . . . . . . . . . . . . 847 1,829 2.0 7.3

8 Other noninfectious gastroenteritis and colitis . . . . . . . . . . . . . . . . . . . . . 558 1,805 2.0 7.2

9 Contusion of lower limb and of other and unspecified sites . . . . . . . . . . . . 924 1,784 2.0 7.1

10 Open wound of finger(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 883 1,617 1.8 6.4

11 Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493 1,467 1.6 5.8

12 Sprains and strains of ankle and foot . . . . . . . . . . . . . . . . . . . . . . . . . . 845 1,357 1.5 5.4

13 Other disorders of urethra and urinary tract . . . . . . . . . . . . . . . . . . . . . . 599 1,340 1.5 5.3

14 Open wound of other and unspecified sites, except limbs . . . . . . . . . . . . . 879 1,295 1.4 5.1

15 Contusion of upper limb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 923 1,273 1.4 5.1

16 Acute pharyngitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 462 1,260 1.4 5.0

17 Symptoms involving head and neck . . . . . . . . . . . . . . . . . . . . . . . . . . . 784 1,244 1.4 4.9

18 Pneumonia, organism unspecified . . . . . . . . . . . . . . . . . . . . . . . . . . . . 486 1,142 1.3 4.5

19 Bronchitis, not specified as acute or chronic . . . . . . . . . . . . . . . . . . . . . . 490 1,041 1.2 4.1

20 Other and unspecified disorders of back . . . . . . . . . . . . . . . . . . . . . . . . 724 991 1.1 3.9

21 Contusion of face, scalp, and neck except eye(s) . . . . . . . . . . . . . . . . . . 920 877 1.0 3.5

22 Viral infection in conditions classified elsewhere and of unspecified site . . . . . 079 876 1.0 3.5

23 Contusion of trunk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 922 763 0.8 3.0

24 Acute bronchitis and bronchiolitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 466 744 0.8 3.0

25 Migraine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 346 744 0.8 3.0

26 Other cellulitis and abscess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 682 739 0.8 2.9

27 Injury, other and unspecified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 959 731 0.8 2.9

28 Certain adverse effects, not elsewhere classified . . . . . . . . . . . . . . . . . . . 995 699 0.8 2.8

29 Other disorders of soft tissues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 729 690 0.8 2.7

30 Open wound of hand except finger(s) alone . . . . . . . . . . . . . . . . . . . . . . 882 677 0.8 2.7

31 Heart failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 428 652 0.7 2.6

32 Other and unspecified aftercare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V58 628 0.7 2.5

33 Cardiac dysrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427 601 0.7 2.4

34 Neurotic disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300 592 0.7 2.4

35 Intracranial injury of other and unspecified nature . . . . . . . . . . . . . . . . . . 854 577 0.6 2.3

36 Open wound of knee, leg (except thigh), and ankle . . . . . . . . . . . . . . . . . 891 565 0.6 2.2

37 Sprains and strains of knee and leg . . . . . . . . . . . . . . . . . . . . . . . . . . . 844 560 0.6 2.2

38 Other and unspecified disorders of joint . . . . . . . . . . . . . . . . . . . . . . . . 719 553 0.6 2.2

39 Disorders of conjunctiva . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 372 551 0.6 2.2

40 Sprains and strains of wrist and hand . . . . . . . . . . . . . . . . . . . . . . . . . . 842 521 0.6 2.1

41 Fracture of radius and ulna . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 813 518 0.6 2.1

42 Contact dermatitis and other eczema . . . . . . . . . . . . . . . . . . . . . . . . . . 692 516 0.6 2.1

43 Chronic sinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 473 512 0.6 2.0

44 Gastritis and duodenitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 535 511 0.6 2.0

45 Superficial injury of eye and adnexa . . . . . . . . . . . . . . . . . . . . . . . . . . 918 505 0.6 2.0

46 Other and ill-defined sprains and strains . . . . . . . . . . . . . . . . . . . . . . . . 848 500 0.6 2.0

47 Acute tonsillitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 463 487 0.5 1.9

48 Fracture of one or more phalanges of hand . . . . . . . . . . . . . . . . . . . . . . 816 483 0.5 1.9

49 Observation and evaluation for suspected conditions . . . . . . . . . . . . . . . . V71 483 0.5 1.9

50 Symptoms involving urinary system . . . . . . . . . . . . . . . . . . . . . . . . . . . 788 469 0.5 1.9

51 Acute myocardial infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410 451 0.5 1.8

52 Streptococcal sore throat and scarlet fever . . . . . . . . . . . . . . . . . . . . . . 034 426 0.5 1.7

53 Symptoms involving skin and other integumentary tissue . . . . . . . . . . . . . . 782 416 0.5 1.7

54 Calculus of kidney and ureter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 592 399 0.4 1.6

55 Disorders of fluid, electrolyte, and acid-base balance . . . . . . . . . . . . . . . . 276 397 0.4 1.6

56 Other diseases of respiratory system . . . . . . . . . . . . . . . . . . . . . . . . . . 519 391 0.4 1.6

57 Open wound of elbow, forearm, and wrist . . . . . . . . . . . . . . . . . . . . . . . 881 390 0.4 1.6

58 Other personal history presenting hazards to health . . . . . . . . . . . . . . . . . V15 390 0.4 1.5

59 Disorders of external ear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 380 385 0.4 1.5

60 Sprains and strains of sacroiliac region . . . . . . . . . . . . . . . . . . . . . . . . . 846 385 0.4 1.5

. . . All other diagnoses ........................................ 32,902 36.6 130.8

. . . Category not applicable.

1Based on the International Classification of Diseases, 9th Revision, Clinical Modification, ICD–9–CM (11).

2Based on U.S. Bureau of the Census estimates of the civilian, noninstitutionalized population of the United States as of July 1, 1992.

NOTE: Numbers may not add to totals because of rounding.

42
Table 21. Number, percent distribution, and annual rate of emergency department visits by patient’s age, sex, race, and 10 most frequent

principal diagnoses: United States, 1992

Selected patient characteristic,

principal diagnosis, and ICD–9–CM code1

Number of

visits in

thousands

Percent

distribution

Number of

visits per

1,000 persons

per year2

Age

All ages:

All visits .............................................. 89,796 100.0 357.1

Suppurative and unspecified otitis media . . . . . . . . . . . . . . . . . . . . . 382 3,162 3.5 12.6

Symptoms involving respiratory system and other chest symptoms . . . . . 786 2,667 3.0 10.6

Other open wound of head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 873 2,578 2.9 10.3

Other symptoms involving abdomen and pelvis . . . . . . . . . . . . . . . . . 789 2,353 2.6 9.4

General symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 780 2,340 2.6 9.3

Acute upper respiratory infections of multiple or unspecified sites . . . . . . 465 1,998 2.2 7.9

Sprains and strains of other and unspecified parts of back . . . . . . . . . . 847 1,829 2.0 7.3

Other noninfectious gastroenteritis and colitis . . . . . . . . . . . . . . . . . . 558 1,805 2.0 7.2

Contusion of lower limb and of other and unspecified sites . . . . . . . . . . 924 1,784 2.0 7.1

Open wound of finger(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 883 1,617 1.8 6.4

All other diagnoses ..................................... 67,663 75.4 269.1

Under 15 years:

All visits .............................................. 22,523 100.0 399.0

Suppurative and unspecified otitis media . . . . . . . . . . . . . . . . . . . . . 382 2,773 12.3 49.1

Acute upper respiratory infections of multiple or unspecified sites . . . . . . 465 1,293 5.7 22.9

Other open wound of head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 873 1,244 5.5 22.0

Other noninfectious gastroenteritis and colitis . . . . . . . . . . . . . . . . . . 558 902 4.0 16.0

General symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 780 631 2.8 11.2

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493 579 2.6 10.2

Acute pharyngitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 462 525 2.3 9.3

Open wound of other and unspecified site . . . . . . . . . . . . . . . . . . . . 879 469 2.1 8.3

Viral infection in conditions classified elsewhere . . . . . . . . . . . . . . . . 079 450 2.0 8.0

Contusion of lower limb and of other and unspecified sites . . . . . . . . . . 924 379 1.7 6.7

All other diagnoses ..................................... 13,278 59.0 235.2

15–24 years:

All visits .............................................. 14,848 100.0 431.8

Other symptoms involving abdomen and pelvis . . . . . . . . . . . . . . . . . 789 578 3.9 16.8

Sprains and strains of other and unspecified parts of back . . . . . . . . . . 847 506 3.4 14.7

Sprains and strains of ankle and foot . . . . . . . . . . . . . . . . . . . . . . . 845 435 2.9 12.7

Open wound of finger(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 883 404 2.7 11.7

Contusion of lower limb and of other and unspecified sites . . . . . . . . . . 924 361 2.4 10.5

Other open wound of head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 873 336 2.3 9.8

Contusion of upper limb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 923 315 2.1 9.2

Acute pharyngitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 462 294 2.0 8.6

Other disorders of urethra and urinary tract . . . . . . . . . . . . . . . . . . . 599 262 1.8 7.6

Other noninfectious gastroenteritis and colitis . . . . . . . . . . . . . . . . . . 558 260 1.8 7.6

All other diagnoses ..................................... 11,097 74.7 322.7

25–44 years:

All visits .............................................. 27,240 100.0 334.9

Sprains and strains of other and unspecified parts of back . . . . . . . . . . 847 929 3.4 11.4

Symptoms involving respiratory system and other chest symptoms . . . . . 786 803 2.9 9.9

Other symptoms involving abdomen and pelvis . . . . . . . . . . . . . . . . . 789 753 2.8 9.3

Open wound of fingers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 883 639 2.3 7.9

Contusion of lower limb and of other and unspecified sites . . . . . . . . . . 924 630 2.3 7.7

Symptoms involving head and neck . . . . . . . . . . . . . . . . . . . . . . . . 784 571 2.1 7.0

General symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 780 547 2.0 6.7

Other open wound of head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 873 515 1.9 6.3

Migraine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 346 469 1.7 5.8

Sprains and strains of ankle and foot . . . . . . . . . . . . . . . . . . . . . . . 845 449 1.6 5.5

All other diagnoses ..................................... 20,935 76.9 257.4

45–64 years:

All visits .............................................. 12,509 100.0 257.9

Symptoms involving respiratory system and other chest symptoms . . . . . 786 730 5.8 15.0

Other symptoms involving abdomen and pelvis . . . . . . . . . . . . . . . . . 789 489 3.9 10.1

General symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 780 342 2.7 7.1

Open wound of fingers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 883 273 2.2 5.6

43
Table 21. Number, percent distribution, and annual rate of emergency department visits by patient’s age, sex, race, and 10 most frequent

principal diagnoses: United States, 1992—Con.

Selected patient characteristic,

principal diagnosis, and ICD–9–CM code1

Number of

visits in

thousands

Percent

distribution

Number of

visits per

1,000 persons

per year2

45–64 years:—Con.

Contusion of lower limb and of other and unspecified sites . . . . . . . . . . 924 255 2.0 5.3

Symptoms involving head and neck . . . . . . . . . . . . . . . . . . . . . . . . 784 241 1.9 5.0

Other and unspecified disorders of back . . . . . . . . . . . . . . . . . . . . . 724 226 1.8 4.7

Other open wound of head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 873 220 1.8 4.5

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493 197 1.6 4.1

Other disorders of urethra and urinary tract . . . . . . . . . . . . . . . . . . . 599 195 1.6 4.0

All other diagnoses ..................................... 9,342 74.7 192.6

65–74 years:

All visits .............................................. 5,806 100.0 314.3

Symptoms involving respiratory system and other chest symptoms . . . . . 786 356 6.1 19.3

General symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 780 229 3.9 12.4

Pneumonia, organism unspecified . . . . . . . . . . . . . . . . . . . . . . . . . 486 176 3.0 9.6

Heart failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 428 159 2.7 8.6

Chronic airway obstruction, not elsewhere classified . . . . . . . . . . . . . . 496 145 2.5 7.8

Other disorders of urethra and urinary tract . . . . . . . . . . . . . . . . . . . 599 141 2.4 7.7

Cardiac dysrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427 139 2.4 7.5

Other open wound of head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 873 127 2.2 6.9

Other symptoms involving abdomen and pelvis . . . . . . . . . . . . . . . . . 789 120 2.1 6.5

Acute myocardial infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410 109 1.9 5.9

All other diagnoses ..................................... 4,103 70.7 222.2

75 years and over:

All visits .............................................. 6,871 100.0 557.6

Symptoms involving respiratory system and other chest symptoms . . . . . 786 373 5.4 30.2

General symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 780 355 5.2 28.8

Heart failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 428 320 4.7 26.0

Pneumonia, organism unspecified . . . . . . . . . . . . . . . . . . . . . . . . . 486 275 4.0 22.3

Other disorders of urethra and urinary tract . . . . . . . . . . . . . . . . . . . 599 220 3.2 17.8

Cardiac dysrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427 197 2.9 16.0

Other symptoms involving abdomen and pelvis . . . . . . . . . . . . . . . . . 789 173 2.5 14.0

Disorders of fluid, electrolyte, and acid-base balance . . . . . . . . . . . . . 276 171 2.5 13.9

Fracture of neck of femur . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 820 138 2.0 11.2

Other open wound of head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 873 136 2.0 11.1

All other diagnoses ..................................... 4,513 65.7 366.2

Sex

Female:

All visits .............................................. 46,612 100.0 360.6

Other symptoms involving abdomen and pelvis . . . . . . . . . . . . . . . . . 789 1,587 3.4 12.3

Suppurative and unspecified otitis media . . . . . . . . . . . . . . . . . . . . . 382 1,559 3.3 12.1

Symptoms involving respiratory system and other chest symptoms . . . . . 786 1,396 3.0 10.8

General symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 780 1,135 2.4 8.8

Acute upper respiratory infections of multiple or unspecified sites . . . . . . 465 1,094 2.3 8.5

Other noninfectious gastroenteritis and colitis . . . . . . . . . . . . . . . . . . 558 1,075 2.3 8.3

Other disorders of urethra and urinary tract . . . . . . . . . . . . . . . . . . . 599 1,032 2.2 8.0

Contusion of lower limb and of other and unspecified sites . . . . . . . . . . 924 917 2.0 7.1

Other open wound of head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 873 910 2.0 7.0

Sprains and strains of other and unspecified parts of back . . . . . . . . . . 847 863 1.9 6.7

All other diagnoses ..................................... 35,043 75.2 271.1

Male:

All visits .............................................. 43,184 100.0 353.4

Other open wound of head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 873 1,668 3.9 13.7

Suppurative and unspecified otitis media . . . . . . . . . . . . . . . . . . . . . 382 1,603 3.7 13.1

Symptoms involving respiratory system and other chest symptoms . . . . . 786 1,271 2.9 10.4

General symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 780 1,205 2.8 9.9

Open wound of finger(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 883 1,092 2.5 8.9

Sprains and strains of other and unspecified parts of back . . . . . . . . . . 847 966 2.2 7.9

Acute upper respiratory infections of multiple or unspecified sites . . . . . . 465 904 2.1 7.4

Contusion of lower limb and of other and unspecified sites . . . . . . . . . . 924 866 2.0 7.1

Other symptoms involving abdomen and pelvis . . . . . . . . . . . . . . . . . 789 766 1.8 6.3

Other noninfectious gastroenteritis and colitis . . . . . . . . . . . . . . . . . . 558 730 1.7 6.0

All other diagnoses ..................................... 32,114 74.4 262.8

44
Table 21. Number, percent distribution, and annual rate of emergency department visits by patient’s age, sex, race, and 10 most frequent

principal diagnoses: United States, 1992—Con.

Selected patient characteristic,

principal diagnosis, and ICD–9–CM code1

Number of

visits in

thousands

Percent

distribution

Number of

visits per

1,000 persons

per year2

Race3

White:

All visits .............................................. 70,478 100.0 336.5

Suppurative and unspecified otitis media . . . . . . . . . . . . . . . . . . . . . 382 2,347 3.3 11.2

Symptoms involving respiratory system and other chest symptoms . . . . . 786 2,206 3.1 10.5

Other open wound of head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 873 2,118 3.0 10.1

Other symptoms involving abdomen and pelvis . . . . . . . . . . . . . . . . . 789 1,950 2.8 9.3

General symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 780 1,870 2.7 8.9

Contusion of lower limb and of other and unspecified sites . . . . . . . . . . 924 1,422 2.0 6.8

Open wound of finger(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 883 1,411 2.0 6.7

Sprains and strains of other and unspecified parts of back . . . . . . . . . . 847 1,408 2.0 6.7

Acute upper respiratory infections of multiple or unspecified sites . . . . . . 465 1,374 2.0 6.6

Other noninfectious gastroenteritis and colitis . . . . . . . . . . . . . . . . . . 558 1,343 1.9 6.4

All other diagnoses ..................................... 53,027 75.2 253.2

Black:

All visits .............................................. 17,150 100.0 545.1

Suppurative and unspecified otitis media . . . . . . . . . . . . . . . . . . . . . 382 758 4.4 24.1

Acute upper respiratory infections of multiple or unspecified sites . . . . . . 465 559 3.3 17.8

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493 488 2.8 15.5

Symptoms involving respiratory system and other chest symptoms . . . . . 786 418 2.4 13.3

Other noninfectious gastroenteritis and colitis . . . . . . . . . . . . . . . . . . 558 416 2.4 13.2

Other open wound of head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 873 408 2.4 13.0

General symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 780 400 2.3 12.7

Sprains and strains of other and unspecified parts of back . . . . . . . . . . 847 366 2.1 11.6

Other symptoms involving abdomen and pelvis . . . . . . . . . . . . . . . . . 789 362 2.1 11.5

Contusion of lower limb and of other and unspecified sites . . . . . . . . . . 924 333 1.9 10.6

All other diagnoses ..................................... 12,642 73.7 401.8

1Based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM) (11).

2Based on U.S. Bureau of the Census estimates of the civilian noninstitutionalized population of the United States as of July 1, 1992.

3Estimates for races other than white and black have been omitted because of small sample sizes.

NOTE: Numbers may not add to totals because of rounding.

45
Table 22. Number and percent distribution of emergency department visits by selected principal diagnoses, according to patient’s age,

sex, and race: United States, 1992

Principal diagnosis and ICD–9–CM code1

Age Sex Race2

All

ages

Under 15

years

15–24

years

25–44

years

45–64

years

65 years

and over Female Male White Black

Number of visits in thousands

All visits ................................... 89,796 22,523 14,848 27,240 12,509 12,676 46,612 43,184 70,478 17,150

Infectious and parasitic diseases .............. 001–139 3,113 1,431 588 678 208 209 1,590 1,523 2,100 915

Viral infection in conditions classified

elsewhere and of unspecified site . . . . . . . . . . . . . . 079 876 450 149 196 * * 447 428 630 198

Neoplasms ........................... 140–239 254 * * * 71 113 151 103 223 *

Endocrine, nutritional and metabolic diseases, and

immunity disorders ..................... 240–279 1,087 111 * 247 252 420 609 478 795 286

Mental disorders ........................ 290–319 2,381 75 356 1,258 399 293 1,225 1,156 1,803 504

Diseases of the nervous system and sense

organs ............................. 320–389 6,026 3,296 514 1,363 605 249 3,247 2,779 4,573 1,290

Disorders of conjunctiva . . . . . . . . . . . . . . . . . . . . . 372 551 238 88 155 * * 278 273 343 193

Suppurative and unspecified otitis media . . . . . . . . . . 382 3,162 2,773 125 202 * * 1,559 1,603 2,347 758

Diseases of the circulatory system ............ 390–459 3,875 * * 532 1,194 2,056 2,062 1,813 3,207 608

Diseases of the respiratory system ............ 460–519 10,905 4,324 1,483 2,368 1,175 1,555 6,000 4,905 8,008 2,576

Acute pharyngitis . . . . . . . . . . . . . . . . . . . . . . . . . 462 1,260 526 294 333 * * 742 517 917 315

Acute upper respiratory infections of multiple or

unspecified sites . . . . . . . . . . . . . . . . . . . . . . . . 465 1,998 1,293 248 258 108 91 1,094 904 1,374 559

Pneumonia, organism unspecified . . . . . . . . . . . . . . 486 1,142 288 * 192 155 452 536 606 875 206

Bronchitis, not specified as acute or chronic . . . . . . . . 490 1,041 254 160 356 135 136 638 403 765 249

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493 1,467 579 207 395 197 89 800 667 925 488

Diseases of the digestive system ............. 520–579 5,469 1,354 791 1,598 796 931 3,023 2,446 4,181 1,140

Other noninfectious gastroenteritis and colitis . . . . . . . 558 1,805 902 260 328 184 131 1,075 730 1,343 416

Diseases of the genitourinary system ........... 580–629 3,810 311 1,017 1,494 461 528 2,694 1,116 2,804 943

Other disorders of urethra and urinary tract . . . . . . . . . 599 1,340 116 262 406 195 361 1,032 308 1,016 303

Diseases of the skin and subcutaneous

tissue .............................. 680–709 2,666 678 422 884 388 294 1,270 1,396 2,004 580

Diseases of the musculoskeletal system and

connective tissue ...................... 710–739 3,812 363 470 1,549 808 622 2,261 1,551 2,944 814

Other and unspecified disorders of back . . . . . . . . . . . 724 991 * 144 428 226 143 573 418 805 174

Other disorders of soft tissues . . . . . . . . . . . . . . . . . 729 690 * 95 261 157 122 420 271 489 189

Symptoms, signs, and ill-defined

conditions ........................... 780–799 10,484 1,488 1,463 3,164 2,090 2,280 5,791 4,693 8,547 1,709

General symptoms . . . . . . . . . . . . . . . . . . . . . . . . 780 2,340 631 237 547 342 584 1,135 1,205 1,870 400

Symptoms involving head and neck . . . . . . . . . . . . . 784 1,244 84 138 571 241 210 813 431 1,030 197

Symptoms involving respiratory system and other

chest symptoms . . . . . . . . . . . . . . . . . . . . . . . . . 786 2,667 193 212 803 730 729 1,396 1,271 2,206 418

Other symptoms involving abdomen and pelvis . . . . . . 789 2,353 239 578 753 489 293 1,587 766 1,950 362

Injury and poisoning ..................... 800–999 29,389 7,615 6,156 9,871 3,308 2,439 12,851 16,537 24,513 4,183

Sprains and strains of ankle and foot . . . . . . . . . . . . 845 1,357 289 435 449 133 * 638 720 1,163 173

Sprains and strains of other and unspecified

parts of back . . . . . . . . . . . . . . . . . . . . . . . . . . . 847 1,829 83 506 929 188 124 863 966 1,408 366

Other open wound of head . . . . . . . . . . . . . . . . . . . 873 2,578 1,244 336 515 220 263 910 1,668 2,118 408

Open wound of other and unspecified sites,

except limbs . . . . . . . . . . . . . . . . . . . . . . . . . . . 879 1,295 469 246 340 146 94 573 722 1,058 190

Open wound of finger(s) . . . . . . . . . . . . . . . . . . . . 883 1,617 222 404 639 273 * 526 1,092 1,411 170

Contusion of upper limb . . . . . . . . . . . . . . . . . . . . . 923 1,273 310 315 438 129 81 659 614 1,126 103

Contusion of lower limb and of other and

unspecified sites . . . . . . . . . . . . . . . . . . . . . . . . 924 1,784 379 361 630 255 159 917 866 1,422 333

Supplementary classification ................ V01–V82 3,000 684 600 1,010 335 371 1,537 1,463 2,318 599

All other diagnoses3 ........................... 1,227 170 455 488 * 73 1,044 183 837 356

Unknown4 .................................. 2,297 569 401 706 381 241 1,257 1,040 1,622 621

Percent distribution

All visits ................................... 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Infectious and parasitic diseases .............. 001–139 3.5 6.4 4.0 2.5 1.7 1.7 3.4 3.5 3.0 5.3

Viral infection in conditions classified elsewhere

and of unspecified site . . . . . . . . . . . . . . . . . . . . . 079 1.0 2.0 1.0 0.7 * * 1.0 1.0 0.9 1.2

Neoplasms ........................... 140–239 0.3 * * * 0.6 0.9 0.3 0.2 0.3 *

Endocrine, nutritional and metabolic diseases,

and immunity disorders ................... 240–279 1.2 * 0.4 0.9 2.0 3.3 1.3 1.1 1.1 1.7

46
Table 22. Number and percent distribution of emergency department visits by selected principal diagnoses, according to patient’s age,

sex, and race: United States, 1992—Con.

Principal diagnosis and ICD–9–CM code1

Age Sex Race2

All

ages

Under 15

years

15–24

years

25–44

years

45–64

years

65 years

and over Female Male White Black

Percent distribution

Mental disorders ........................ 290–319 2.7 0.3 2.4 4.6 3.2 2.3 2.6 2.7 2.6 2.9

Diseases of the nervous system and sense

organs ............................. 320–389 6.7 14.6 3.5 5.0 4.8 2.0 7.0 6.4 6.5 7.5

Disorders of conjunctiva . . . . . . . . . . . . . . . . . . . . . 372 0.6 1.1 0.6 0.6 * * 0.6 0.6 0.5 1.1

Suppurative and unspecified otitis media . . . . . . . . . . 382 3.5 12.3 0.8 0.7 * * 3.3 3.7 3.3 4.4

Diseases of the circulatory system ............ 390–459 4.3 * * 2.0 9.5 16.2 4.4 4.2 4.6 3.5

Diseases of the respiratory system ............ 460–519 12.1 19.2 10.0 8.7 9.4 12.3 12.9 11.4 11.4 15.0

Acute pharyngitis . . . . . . . . . . . . . . . . . . . . . . . . . 462 1.4 2.3 2.0 1.2 * * 1.6 1.2 1.3 5.3

Acute upper respiratory infections of multiple or

unspecified sites . . . . . . . . . . . . . . . . . . . . . . . . 465 2.2 5.7 1.7 0.9 0.9 0.7 2.3 2.1 2.0 3.3

Pneumonia, organism unspecified . . . . . . . . . . . . . . 486 1.3 1.3 * 0.7 1.2 3.6 1.1 1.4 1.2 1.2

Bronchitis, not specified as acute or chronic . . . . . . . . 490 1.2 1.1 1.1 1.3 1.1 1.1 1.4 0.9 1.1 1.5

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493 1.6 2.6 1.4 1.5 1.6 0.7 1.7 1.5 1.3 2.8

Diseases of the digestive system ............. 520–579 6.1 6.0 5.3 5.9 6.4 7.3 6.5 5.7 5.9 6.6

Other noninfectious gastroenteritis and

colitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 558 2.0 4.0 1.8 1.2 1.5 1.0 2.3 1.7 1.9 2.4

Diseases of the genitourinary system ........... 580–629 4.2 1.4 6.8 5.5 3.7 4.2 5.8 2.6 4.0 5.5

Other disorders of urethra and urinary tract . . . . . . . . . 599 1.5 0.5 1.8 1.5 1.6 2.8 2.2 0.7 1.4 1.8

Diseases of the skin and subcutaneous

tissue .............................. 680–709 3.0 3.0 2.8 3.2 3.1 2.3 2.7 3.2 2.8 3.4

Diseases of the musculoskeletal system and

connective tissue ...................... 710–739 4.2 1.6 3.2 5.7 6.5 4.9 4.9 3.6 4.2 4.7

Other and unspecified disorders of back . . . . . . . . . . . 724 1.1 * 1.0 1.6 1.8 1.1 1.2 1.0 1.1 1.0

Other disorders of soft tissues . . . . . . . . . . . . . . . . . 729 0.8 * 0.6 1.0 1.3 1.0 0.9 0.6 0.7 1.1

Symptoms, signs, and ill-defined

conditions ........................... 780–799 11.7 6.6 9.9 11.6 16.7 18.0 12.4 10.9 12.1 10.0

General symptoms . . . . . . . . . . . . . . . . . . . . . . . . 780 2.6 2.8 1.6 2.0 2.7 4.6 2.4 2.8 2.7 2.3

Symptoms involving head and neck . . . . . . . . . . . . . 784 1.4 0.4 0.9 2.1 1.9 1.7 1.7 1.0 1.5 1.2

Symptoms involving respiratory system and other

chest symptoms . . . . . . . . . . . . . . . . . . . . . . . . . 786 3.0 0.9 1.4 2.9 5.8 5.8 3.0 2.9 3.1 2.4

Other symptoms involving abdomen and

pelvis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 789 2.6 1.1 3.9 2.8 3.9 2.3 3.4 1.8 2.8 2.1

Injury and poisoning ..................... 800–999 32.7 33.8 41.5 36.2 26.4 19.2 27.6 38.3 34.8 24.4

Sprains and strains of ankle and foot . . . . . . . . . . . . 845 1.5 1.3 2.9 1.6 1.1 * 1.4 1.7 1.6 1.0

Sprains and strains of other and unspecified parts

of back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 847 2.0 0.4 3.4 3.4 1.5 1.0 1.9 2.2 2.0 2.1

Other open wound of head . . . . . . . . . . . . . . . . . . . 873 2.9 5.5 2.3 1.9 1.8 2.1 2.0 3.9 3.0 2.4

Open wound of other and unspecified sites, except

limbs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 879 1.4 2.1 1.7 1.2 1.2 0.7 1.2 1.7 1.5 1.1

Open wound of finger(s) . . . . . . . . . . . . . . . . . . . . 883 1.8 1.0 2.7 2.3 2.2 * 1.1 2.5 2.0 1.0

Contusion of upper limb . . . . . . . . . . . . . . . . . . . . . 923 1.4 1.4 2.1 1.6 1.0 0.6 1.4 1.4 1.6 0.6

Contusion of lower limb and of other and

unspecified sites . . . . . . . . . . . . . . . . . . . . . . . . 924 2.0 1.7 2.4 2.3 2.0 1.3 2.0 2.0 2.0 1.9

Supplementary classification ................ V01–V82 3.3 3.0 4.0 3.7 2.7 2.9 3.3 3.4 3.3 3.5

All other diagnoses3 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.4 0.8 3.1 1.8 * 0.6 2.2 0.4 1.2 2.1

Unknown4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.6 2.5 2.7 2.6 3.0 1.9 2.7 2.4 2.3 3.6

* Figure does not meet standard of reliability or precision.

1Based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM) (11).

2Estimates for races other than white and black have been omitted because of small sample sizes.

3Includes diseases of the blood and blood-forming organs (280–289); complications of pregnancy, childbirth, and the puerperium (630–676); congenital anomalies (740–759); and certain conditions

originating in the perinatal period (760–779).

4Includes blank diagnoses, uncodable diagnoses, and illegible diagnoses.

NOTE: Numbers may not add to totals because of rounding.

47
Table 23. Number and percent distribution of emergency department visits by patient’s age, sex, and race, according to selected

principal diagnoses: United States, 1992

Principal diagnosis and

ICD–9–CM code1

Number of

visits in

thousands

Age Sex Race2

Total

Under

15 years

15–24

years

25–44

years

45–64

years

65 years

and over Female Male White Black

Percent distribution

All visits ........................................ 89,796 100.0 25.1 16.5 30.3 13.9 14.1 51.9 48.1 78.5 19.1

Infectious and parasitic diseases ................... 001–139 3,113 100.0 45.9 18.9 21.8 6.7 6.7 51.1 48.9 67.4 29.4

Viral infection in conditions classified elsewhere and of

unspecified site . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 079 876 100.0 51.4 17.1 22.4 *4.6 *4.5 51.1 48.9 71.9 22.7

Neoplasms ................................ 140–239 254 100.0 * * * 28.0 44.4 59.6 40.4 87.9 *

Endocrine, nutritional and metabolic diseases and

immunity disorders .......................... 240–279 1,087 100.0 10.2 * 22.7 23.2 38.7 56.0 44.0 73.1 26.3

Mental disorders ............................. 290–319 2,381 100.0 3.2 14.9 52.8 16.7 12.3 51.4 48.6 75.8 21.2

Diseases of the nervous system and sense organs ....... 320–389 6,026 100.0 54.7 8.5 22.6 10.0 4.1 53.9 46.1 75.9 21.4

Disorders of conjunctiva . . . . . . . . . . . . . . . . . . . . . . . . . . 372 551 100.0 43.2 16.0 28.1 * * 50.5 49.5 62.3 35.1

Suppurative and unspecified otitis media . . . . . . . . . . . . . . . 382 3,162 100.0 87.7 3.9 6.4 * * 49.3 50.7 74.2 24.0

Diseases of the circulatory system ................. 390–459 3,875 100.0 * * 13.7 30.8 53.1 53.2 46.8 82.8 15.7

Diseases of the respiratory system ................. 460–519 10,905 100.0 39.7 13.6 21.7 10.8 14.3 55.0 45.0 73.4 23.6

Acute pharyngitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 462 1,260 100.0 41.7 23.4 26.4 * * 58.9 41.1 72.8 25.0

Acute upper respiratory infections of multiple or unspecified

sites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 465 1,998 100.0 64.7 12.4 12.9 5.4 4.5 54.8 45.2 68.8 28.0

Pneumonia, organism unspecified . . . . . . . . . . . . . . . . . . . 486 1,142 100.0 25.2 * 16.8 13.5 39.6 46.9 53.1 76.6 18.0

Bronchitis, not specified as acute or chronic . . . . . . . . . . . . . 490 1,041 100.0 24.4 15.4 34.2 13.0 13.1 61.3 38.7 73.5 23.9

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493 1,467 100.0 39.4 14.1 26.9 13.4 6.1 54.6 45.4 63.1 33.2

Diseases of the digestive system .................. 520–579 5,469 100.0 24.8 14.5 29.2 14.6 17.0 55.3 44.7 76.4 20.9

Other noninfectious gastroenteritis and colitis . . . . . . . . . . . . 558 1,805 100.0 50.0 14.4 18.1 10.2 7.3 59.6 40.4 74.4 23.0

Diseases of the genitourinary system ................ 580–629 3,810 100.0 8.2 26.7 39.2 12.1 13.9 70.7 29.3 73.6 24.8

Other disorders of urethra and urinary tract . . . . . . . . . . . . . . 599 1,340 100.0 8.6 19.5 30.3 14.6 27.0 77.0 23.0 75.8 22.6

Diseases of the skin and subcutaneous tissue .......... 680–709 2,666 100.0 25.4 15.8 33.2 14.6 11.0 47.6 52.4 75.2 21.7

Diseases of the musculoskeletal system and connective

tissue ................................... 710–739 3,812 100.0 9.5 12.3 40.6 21.2 16.3 59.3 40.7 77.2 21.3

Other and unspecified disorders of back . . . . . . . . . . . . . . . . 724 991 100.0 * 14.6 43.2 22.8 14.4 57.8 42.2 81.3 17.6

Other disorders of soft tissues . . . . . . . . . . . . . . . . . . . . . . 729 690 100.0 * 13.8 37.8 22.7 17.7 60.8 39.2 70.8 27.3

Symptoms, signs, and ill-defined conditions ............ 780–799 10,484 100.0 14.2 14.0 30.2 19.9 21.7 55.2 44.8 81.5 16.3

General symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 780 2,340 100.0 27.0 10.1 23.4 14.6 24.9 48.5 51.5 79.9 17.1

Symptoms involving head and neck . . . . . . . . . . . . . . . . . . 784 1,244 100.0 6.7 11.1 45.9 19.4 16.9 65.4 34.6 82.8 15.9

Symptoms involving respiratory system and other chest

symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 786 2,667 100.0 7.3 7.9 30.1 27.4 27.3 52.3 47.7 82.7 15.7

Other symptoms involving abdomen and pelvis . . . . . . . . . . . 789 2,353 100.0 10.2 24.6 32.0 20.8 12.5 67.5 32.5 82.9 15.4

Injury and poisoning .......................... 800–999 29,389 100.0 25.9 20.9 33.6 11.3 8.3 43.7 56.3 83.4 14.2

Sprains and strains of ankle and foot . . . . . . . . . . . . . . . . . 845 1,357 100.0 21.3 32.1 33.1 9.8 * 47.0 53.0 85.7 12.7

Sprains and strains of other and unspecified parts of back . . . . 847 1,829 100.0 4.5 27.6 50.8 10.3 6.8 47.2 52.8 77.0 20.0

Other open wound of head . . . . . . . . . . . . . . . . . . . . . . . . 873 2,578 100.0 48.2 13.1 20.0 8.5 10.2 35.3 64.7 82.1 15.8

Open wound of other and unspecified sites, except limbs . . . . . 879 1,295 100.0 36.2 19.0 26.2 11.3 7.3 44.3 55.7 81.7 14.7

Open wound of finger(s) . . . . . . . . . . . . . . . . . . . . . . . . . 883 1,617 100.0 13.7 25.0 39.5 16.9 * 32.5 67.5 87.3 10.5

Contusion of upper limb . . . . . . . . . . . . . . . . . . . . . . . . . . 923 1,273 100.0 24.3 24.7 34.4 10.1 6.4 51.7 48.3 88.4 8.1

Contusion of lower limb and of other and unspecified sites . . . . 924 1,784 100.0 21.3 20.2 35.4 14.3 8.9 51.4 48.6 79.7 18.6

Supplementary classification .................... V01–V82 3,000 100.0 22.8 20.0 33.7 11.2 12.4 51.2 48.8 77.3 20.0

All other diagnoses3 ................................ 1,227 100.0 13.9 37.0 39.8 * 6.0 85.1 14.9 68.2 29.0

Unknown4 ....................................... 2,297 100.0 24.8 17.4 30.7 16.6 10.5 54.7 45.3 70.6 27.0

* Figure does not meet standard of reliability or precision.

1Based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM) (11).

2Estimates for races other than white and black have been omitted because of small sample sizes.

3Includes diseases of the blood and blood-forming organs (280–289); complications of pregnancy, childbirth, and the puerperium (630–676); congenital anomalies (740–759); and certain conditions

originating in the perinatal period (760–779).

4Includes blank diagnoses, uncodable diagnoses, and illegible diagnoses.

NOTE: Numbers may not add to totals because of rounding.

48
Table 24. Number and percent distribution of emergency department visits by selected principal reasons for visit and most frequent

principal diagnoses: United States, 1992

Principal reason for visit, RVC code1,

principal diagnosis, and ICD–9–CM code2

Number of

visits in

thousands

Percent

distribution

All visits ...................................................... 89,796 . . .

Stomach and abdominal pain, cramps and spasms ....................... S545 4,955 100.0

Abdominal pain ............................................ 789.0 1,379 27.8

Other noninfectious gastroenteritis and colitis ......................... 558.9 369 7.4

Gastritis and duodenitis ................................... 535.0–535.6 223 4.5

Urinary tract infection, site not specified ............................. 599.0 201 4.1

Inflammatory disease of ovary, fallopian tube, pelvic cellular tissue, and

peritoneum .......................................... 614.0–614.9 146 2.9

Intestinal obstruction without mention of hernia .................... 560.0–560.9 107 2.2

Constipation .............................................. 564.0 103 2.1

Calculus of gallbladder ................................... 574.0–574.2 101 2.0

Appendicitis, unqualified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 541 101 2.0

All other diagnoses .............................................. 2,224 44.9

Chest pain and related symptoms (not referable to body system) ............... S050 4,625 100.0

Chest pain ............................................... 786.5 1,642 35.5

Acute myocardial infarction ................................. 410.0–410.9 337 7.3

Intermediate coronary syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411.1 298 6.4

Other and unspecified angina pectoris .............................. 413.9 212 4.6

Contusion of chest wall ....................................... 922.1 131 2.8

Pneumonia, organism unspecified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 486 131 2.8

Heart failure .......................................... 428.0–428.9 109 2.3

Other and unspecified disorders of bone and cartilage .................... 733.9 104 2.2

All other diagnoses .............................................. 1,661 35.9

Fever ................................................... S010 3,678 100.0

Suppurative and unspecified otitis media ........................ 382.0–382.9 853 23.2

Pyrexia of unknown origin ..................................... 780.6 362 9.8

Acute upper respiratory infections of multiple or unspecified sites ......... 465.0–465.9 332 9.0

Unspecified viral infection ...................................... 079.9 229 6.2

Pneumonia, organism unspecified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 486 223 6.1

Acute pharyngitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 462 191 5.2

Other noninfectious gastroenteritis and colitis ......................... 558.9 117 3.2

Acute tonsillitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 463 112 3.1

Streptoccocal sore throat and scarlet fever ....................... 034.0–034.1 93 2.5

All other diagnoses .............................................. 1,165 31.7

Headache, pain in head ........................................ S210 2,545 100.0

Headache ............................................... 784.0 587 23.1

Migraine, unspecified ........................................ 346.9 409 16.1

Psychalgia ............................................... 307.8 140 5.5

Contusion of face, scalp, and neck except eye(s) . . . . . . . . . . . . . . . . . . . . . . . . 920 108 4.2

Sprains and strains of neck .................................... 847.0 79 3.1

Intracranial injury of other and unspecified nature ................... 845.0–845.1 75 2.9

All other diagnoses .............................................. 1,146 45.0

Shortness of breath ........................................... S415 2,025 100.0

Heart failure .......................................... 428.0–428.9 292 14.4

Asthma ............................................. 493.0–493.9 266 13.1

Symptoms involving respiratory system and other chest symptoms ........ 786.0–786.9 202 10.0

Chronic airway obstruction, not elsewhere classified . . . . . . . . . . . . . . . . . . . . . . 496 168 8.3

Pneumonia, organism unspecified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 486 131 6.5

All other diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 966 47.7

Cough ................................................... S440 1,997 100.0

Acute upper respiratory infections of multiple or unspecified sites ......... 465.0–465.9 376 18.8

Bronchitis, not specified as acute or chronic . . . . . . . . . . . . . . . . . . . . . . . . . . . 490 281 14.1

Suppurative and unspecified otitis media ........................ 382.0–382.9 235 11.8

Acute bronchitis and bronchiolitis ............................. 466.0–466.1 218 10.9

Asthma ............................................. 493.0–493.9 134 6.7

Pneumonia, organism unspecified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 486 107 5.4

All other diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 645 32.3

49
Table 24. Number and percent distribution of emergency department visits by selected principal reasons for visit and most frequent

principal diagnoses: United States, 1992—Con.

Principal reason for visit, RVC code1,

principal diagnosis, and ICD–9–CM code2

Number of

visits in

thousands

Percent

distribution

Back symptoms ............................................. S905 1,959 100.0

Backache, unspecified ........................................ 724.5 234 11.9

Lumbago ................................................ 724.2 173 8.8

Sprains and strains of lumbar ................................... 847.2 159 8.1

Sprains and strains, unspecified site of back .......................... 847.9 126 6.4

Sprains and strains of sacroiliac region ......................... 846.0–846.9 122 6.2

Sprains and strains of neck, thoracic ........................... 847.0–847.1 91 4.7

All other diagnoses .............................................. 1,053 53.8

Symptoms referable to throat ..................................... S455 1,957 100.0

Acute pharyngitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 462 628 32.1

Streptococcal sore throat and scarlet fever ....................... 034.0–034.1 209 10.7

Acute upper respiratory infections of multiple or unspecified sites ......... 465.0–465.9 202 10.3

Acute tonsillitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 463 200 10.2

Unspecified otitis media ....................................... 382.9 94 4.8

All other diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 624 31.9

Vomiting .................................................. S530 1,877 100.0

Other noninfectious gastroenteritis and colitis ......................... 558.9 509 27.1

Nausea and vomiting ........................................ 787.0 125 6.7

Unspecified otitis media ....................................... 382.9 118 6.3

Gastritis and duodenitis ................................... 535.0–535.6 82 4.4

Intestinal infection due to other organism, not elsewhere classified ............ 008.8 69 3.7

All other diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 974 51.9

Pain, site not referable to specific body system .......................... S055 1,812 100.0

Abdominal pain ............................................ 789.0 192 10.6

Calculus of kidney and ureter ............................... 592.0–592.9 168 9.2

Contusion of chest wall ....................................... 922.1 118 6.5

Chest pain ............................................... 786.5 95 5.2

Closed fracture of ribs ........................................ 807.0 74 4.1

All other diagnoses .............................................. 1,166 64.3

All other reasons ................................................ 62,366 69.5

. . . Category not applicable.

1Based on A Reason for Visit Classification for Ambulatory Care (RVC) (10).

2Based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM) (11).

NOTE: Numbers may not add to totals because of rounding.

50
Table 25. Number and percent of emergency department visits by diagnostic and screening service ordered or provided and selected

principal diagnoses: United States, 1992

Principal diagnosis and ICD–9–CM code2

Number of

visits in

thousands

Diagnostic and screening services ordered or provided1

None

Blood

pressure Urinalysis

Other

blood

test3 EKG4

Chest

x ray

Extremity

x ray

Other

imaging5 Other6

Percent of visits in each diagnosis category

at which service was ordered or provided

All visits ........................................ 89,796 12.1 73.7 15.2 28.8 13.2 16.8 15.1 12.3 24.3

Infectious and parasitic diseases ................... 001–139 3,113 18.5 63.4 21.7 31.0 6.1 11.9 * 3.8 35.8

Viral infection in conditions classified elsewhere and of

unspecified site . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 079 876 18.5 64.9 19.6 35.6 *5.1 16.2 * * 26.0

Neoplasms ................................ 140–239 254 * 84.4 28.0 49.8 * 36.2 * * 29.9

Endocrine, nutritional and metabolic diseases and immunity

disorders ................................. 240–279 1,087 *2.6 87.5 40.1 76.9 32.1 30.7 * 17.8 35.5

Mental disorders ............................. 290–319 2,381 4.6 85.7 14.5 41.4 19.2 12.8 2.7 9.0 36.1

Diseases of the nervous system and sense organs ....... 320–389 6,026 30.1 56.2 4.7 11.5 3.1 5.2 * 4.3 23.6

Disorders of conjunctiva . . . . . . . . . . . . . . . . . . . . . . . . . . 372 551 28.0 57.7 * * * * – * 32.6

Suppurative and unspecified otitis media . . . . . . . . . . . . . . . 382 3,162 43.1 39.7 4.5 7.6 * * * * 22.9

Diseases of the circulatory system ................. 390–459 3,875 2.5 88.3 18.3 71.9 71.1 54.3 2.0 15.1 28.1

Diseases of the respiratory system ................. 460–519 10,905 15.0 67.3 8.8 31.2 12.8 36.6 1.0 5.9 31.0

Acute pharyngitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 462 1,260 22.5 61.6 5.5 17.7 * * * * 37.9

Acute upper respiratory infections of multiple or

unspecified sites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 465 1,998 28.6 53.4 5.1 14.2 * 17.2 * * 27.6

Pneumonia, organism unspecified . . . . . . . . . . . . . . . . . . . 486 1,142 * 77.9 25.8 64.9 34.0 88.5 * 10.1 38.4

Bronchitis, not specified as acute or chronic . . . . . . . . . . . . . 490 1,041 13.3 69.2 *5.2 29.2 12.6 47.4 * * 25.9

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493 1,467 11.9 71.1 * 29.0 9.3 35.4 * * 32.9

Diseases of the digestive system .................. 520–579 5,469 9.6 76.1 27.8 51.9 16.1 14.8 2.2 19.7 24.7

Other noninfectious gastroenteritis and colitis . . . . . . . . . . . . 558 1,805 14.6 65.9 28.0 48.4 6.5 7.6 * 12.7 29.7

Diseases of the genitourinary system ................ 580–629 3,810 2.7 81.1 72.6 52.8 5.5 7.9 3.1 15.8 36.7

Other disorders of urethra and urinary tract . . . . . . . . . . . . . . 599 1,340 * 82.0 90.7 52.7 8.5 13.6 * 7.5 27.6

Diseases of the skin and subcutaneous tissue .......... 680–709 2,666 20.8 71.6 3.7 14.9 3.1 4.8 9.5 * 17.7

Diseases of the musculoskeletal system and connective

tissue ................................... 710–739 3,812 8.0 78.9 10.4 17.0 8.4 11.3 26.4 16.9 16.8

Other and unspecified disorders of back . . . . . . . . . . . . . . . . . . . 991 * 81.7 18.7 15.1 * 6.8 10.1 26.4 14.9

Other disorders of soft tissues . . . . . . . . . . . . . . . . . . . . . . 729 690 * 81.2 11.1 23.2 16.2 20.4 22.5 11.7 24.1

Symptoms, signs, and ill-defined conditions ............ 780–799 10,484 6.0 80.5 27.1 57.0 33.5 31.2 2.2 18.7 28.6

General symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 780 2,340 9.7 71.6 21.5 64.6 33.9 27.1 * 16.2 33.5

Symptoms involving head and neck . . . . . . . . . . . . . . . . . . 784 1,244 7.4 86.6 * 25.2 7.6 * * 17.4 19.4

Symptoms involving respiratory system and other chest

symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 786 2,667 * 87.4 11.0 62.9 72.6 68.9 * 10.7 29.6

Other symptoms involving abdomen and pelvis . . . . . . . . . . . 789 2,353 3.2 82.6 56.8 70.8 14.3 17.2 * 34.3 29.6

Injury and poisoning .......................... 800–999 29,389 10.0 75.2 5.5 8.6 3.8 7.3 37.9 13.9 17.8

Sprains and strains of ankle and foot . . . . . . . . . . . . . . . . . . 84 1,357 * 76.7 * * – * 83.4 * 11.6

Sprains and strains of other and unspecified parts of back . . . . 847 1,829 3.5 82.2 9.3 5.9 * 8.5 28.3 42.7 16.1

Other open wound of head . . . . . . . . . . . . . . . . . . . . . . . . 873 2,578 23.0 66.4 * 5.9 * * 8.7 13.2 19.7

Open wound of other and unspecified sites, except limbs . . . . . 879 1,295 28.2 62.3 * 6.7 * * 13.1 * 12.3

Open wound of fingers . . . . . . . . . . . . . . . . . . . . . . . . . . 883 1,617 14.9 75.6 * * * * 22.0 * 12.4

Contusion of upper limb . . . . . . . . . . . . . . . . . . . . . . . . . . 923 1,273 * 73.5 * * * * 81.8 5.7 14.3

Contusion of lower limb and of other and unspecified sites . . . . 924 1,784 * 76.3 5.6 6.2 * 8.0 72.0 14.9 19.6

Supplementary classification .................... V01–V82 3,000 22.2 64.3 10.3 18.6 5.7 6.5 4.0 7.5 24.3

All other diagnoses7 ................................ 1,227 8.2 77.4 33.2 62.5 5.6 8.3 * 16.5 30.2

Unknown8 ....................................... 2,297 33.2 55.3 7.6 16.7 6.1 7.6 5.9 6.7 15.4

* Figures does not meet standard of reliability or precision.

– Quantity zero.

1More than one diagnostic or screening service may be reported per visit.

2Based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM) (11).

3Includes HIV (human immunodeficiency virus) serology and ‘‘other’’ blood test.

4EKG is electrocardiogram.

5Includes CT scan/MRI and ‘‘other’’ diagnostic imaging.

6Includes mental status exam and ‘‘other’’ diagnostic service.

7Includes diseases of the blood and blood-forming organs (280–289); complications of pregnancy, childbirth, and the puerperium (630–676); congenital anomalies (740–759); and certain conditions

originating in the perinatal period (760–779).

8Includes blank diagnoses, uncodable diagnoses, and illegible diagnoses.

NOTE: Example of use of table - 47.4 percent of visits with a principal diagnosis of bronchitis (ICD–9–CM code 490) included a chest x ray.

51
Table 26. Number and percent of emergency department visits by procedures provided and patient’s age, sex, and race:

United States, 1992

Procedures provided

Age Sex Race1

All

ages

Under

15 years

15–24

years

25–44

years

45–64

years

65–74

years

75 years

and over Female Male White Black

Number of visits in thousands2

All visits 89,796 22,523 14,848 27,240 12,509 5,806 6,871 46,612 43,184 70,478 17,150

None ................................ 51,782 14,804 8,610 16,124 6,621 2,696 2,928 28,636 23,147 38,984 11,495

IV fluids3 ............................. 12,955 927 1,390 3,362 2,841 1,850 2,585 6,956 5,998 10,810 1,844

Wound care ........................... 11,550 3,152 2,280 3,669 1,402 489 559 4,203 7,347 9,538 1,725

Orthopedic care ......................... 7,072 1,754 1,500 2,274 892 379 273 3,254 3,818 6,153 749

Eye/ENT care4 .......................... 2,484 660 431 939 285 96 * 1,088 1,396 2,019 409

Bladder catheter ......................... 2,319 138 342 508 324 344 664 1,456 863 1,959 343

NG tube/gastric lavage5 . . . . . . . . . . . . . . . . . . . . 878 82 169 261 130 108 129 441 437 735 120

Endotracheal intubation . . . . . . . . . . . . . . . . . . . . 408 * * * 79 98 127 169 239 377 *

CPR6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291 * * * * * 114 114 177 266 *

Lumbar puncture . . . . . . . . . . . . . . . . . . . . . . . . 244 125 * * * * * 125 119 183 *

Other ................................ 6,692 1,633 1,090 1,812 1,027 552 578 3,318 3,374 5,229 1,278

Percent

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... ... ... ... ... ... ... ... ... ... ...

None ................................ 57.7 65.7 58.0 59.2 52.9 46.4 42.6 61.4 53.6 55.3 67.0

IV fluids3 ............................. 14.4 4.1 9.4 12.3 22.7 31.9 37.6 14.9 13.9 15.3 10.8

Wound care ........................... 12.9 14.0 15.4 13.5 11.2 8.4 8.1 9.0 17.0 13.5 10.1

Orthopedic care . . . . . . . . . . . . . . . . . . . . . . . . . 7.9 7.8 10.1 8.3 7.1 6.5 4.0 7.0 8.8 8.7 4.4

Eye/ENT care4 . . . . . . . . . . . . . . . . . . . . . . . . . . 2.8 2.9 2.9 3.4 2.3 1.7 * 2.3 3.2 2.9 2.4

Bladder catheter . . . . . . . . . . . . . . . . . . . . . . . . . 2.6 0.6 2.3 1.9 2.6 5.9 9.7 3.1 2.0 2.8 2.0

NG tube/gastric lavage5 . . . . . . . . . . . . . . . . . . . . 1.0 0.4 1.1 1.0 1.0 1.9 1.9 0.9 1.0 1.0 0.7

Endotracheal intubation . . . . . . . . . . . . . . . . . . . . 0.5 * * * 0.6 1.7 1.9 0.4 0.6 0.5 *

CPR6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.3 * * * * * 1.7 0.2 0.4 0.4 *

Lumbar puncture . . . . . . . . . . . . . . . . . . . . . . . . 0.3 0.6 * * * * * 0.3 0.3 0.3 *

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.5 7.3 7.3 6.7 8.2 9.5 8.4 7.1 7.8 7.4 7.5

. . . Category not applicable.

* Figure does not meet standard of reliability or precision.

1Estimates for races other than white and black have been omitted because of small sample sizes.

2Numbers may not add to totals because more than one procedure may be reported per visit.

3IV is intravenous.

4ENT is ears, nose, and throat.

5NG is nasogastric.

6CPR is cardiopulmonary resuscitation.

NOTE: Example of use of table: 37.6 percent of visits by persons 75 years and over included the administration of IV fluids.

52
Table 27. Number and percent distribution of emergency department visits by medication therapy, according to patient’s age, sex, and

race: United States, 1992

Medication therapy1

Age Sex Race2

All

ages

Under

15 years

15–24

years

25–44

years

45–64

years

65–74

years

75 years

and over Female Male White Black

Medication therapy ordered or provided at visit Number of visits in thousands

All visits ................................. 89,796 22,523 14,848 27,240 12,509 5,806 6,871 46,612 43,184 70,478 17,150

Drug visits3 ............................... 62,088 14,837 9,933 19,611 9,280 4,025 4,402 32,841 29,248 48,628 12,059

Visits without mention of medication ................ 27,707 7,686 4,915 7,629 3,230 1,780 2,468 13,771 13,936 21,850 5,090

Number of medications ordered or provided at visit

All visits ................................. 89,796 22,523 14,848 27,240 12,509 5,806 6,871 46,612 43,184 70,478 17,150

None ................................... 27,707 7,686 4,915 7,629 3,229 1,780 2,468 13,771 13,936 21,850 5,090

1 ..................................... 29,271 7,617 5,227 9,361 3,745 1,529 1,792 14,899 14,373 22,728 5,893

2 ..................................... 18,855 4,698 3,117 6,103 2,746 1,109 1,082 10,309 8,546 14,744 3,685

3 ..................................... 8,070 1,863 1,071 2,578 1,320 541 698 4,365 3,706 6,322 1,548

4 ..................................... 3,231 454 375 946 772 349 334 1,655 1,576 2,554 602

5 or more ................................ 2,660 204 143 622 697 498 496 1,613 1,047 2,280 333

Medication therapy ordered or provided at visit Percent distribution

All visits ................................. 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Drug visits3 ............................... 69.1 65.9 66.9 72.0 74.2 69.3 64.1 70.5 67.7 69.0 70.3

Visits without mention of medication ................ 30.9 34.1 33.1 28.0 25.8 30.7 35.9 29.5 32.3 31.0 29.7

Number of medications ordered or provided at visit

All visits ................................. 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

None ................................... 30.9 34.1 33.1 28.0 25.8 30.7 35.9 29.5 32.3 31.0 29.7

1 ..................................... 32.6 33.8 35.2 34.4 29.9 26.3 26.1 32.0 33.3 32.2 34.4

2 ..................................... 21.0 20.9 21.0 22.4 22.0 19.1 15.7 22.1 19.8 20.9 21.5

3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.0 8.3 7.2 9.5 10.5 9.3 10.2 9.4 8.6 9.0 9.0

4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.6 2.0 2.5 3.5 6.2 6.0 4.9 3.6 3.6 3.6 3.5

5 or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.0 0.9 1.0 2.3 5.6 8.6 7.2 3.5 2.4 3.2 1.9

1Includes prescription drugs, over-the-counter medications, immunizing agents, and desensitizing agents.

2Estimates for races other than white and black have been omitted because of small sample sizes.

3Visits at which one or more drugs were provided or prescribed.

NOTE: Numbers may not add to totals because of rounding.

53
Table 28. Number and percent distribution of drug mentions at emergency department visits by therapeutic classification:

United States, 1992

Therapeutic classification1

Number of drug

mentions in thousands

Percent

distribution

All drug mentions ....................................... 117,419 100.0

Drugs used for relief of pain ................................ 34,993 29.8

General analgesics ..................................... 22,904 19.5

Antiarthritics ......................................... 11,283 9.6

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 806 0.7

Antimicrobial agents ..................................... 19,576 16.7

Penicillins .......................................... 6,467 5.5

Cephalosporins ....................................... 5,981 5.1

Erythromycins and lincosamides ............................ 2,861 2.4

Sulfanomides and trimethoprim ............................. 1,057 0.9

Miscellaneous antibacterial agents ........................... 1,092 0.9

Tetracyclines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 825 0.7

Urinary tract antiseptics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 624 0.5

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 668 0.6

Respiratory tract drugs .................................... 13,348 11.4

Bronchodilators, antiasthmatics ............................. 5,344 4.6

Nasal decongestants ................................... 4,184 3.6

Antitussives, expectorants, mucolytics ......................... 1,523 0.0

Antihistamines ........................................ 2,286 1.9

Other ............................................. * *

Cardiovascular-renal drugs ................................. 7,585 6.5

Antianginal agents ..................................... 3,075 2.6

Diuretics ........................................... 1,699 1.4

Antihypertensive agents .................................. 1,445 1.2

Cardiac glycosides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 602 0.5

Antiarrhythmic agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 402 0.3

Agents used in peripheral or cerebral vascular disorders . . . . . . . . . . . . . 168 0.1

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192 0.4

Psychopharmacological drugs ............................... 5,934 5.1

Sedatives and hypnotics ................................. 2,156 1.8

Antianxiety agents ..................................... 1,799 1.5

Antipsychotic drugs .................................... 1,538 1.3

Antidepressants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 418 0.4

Other ............................................. * *

Gastrointestinal agents .................................... 5,565 4.7

Agents used in disorders of upper GI tract ...................... 2,945 2.5

Miscellaneous gastrointestinal agents ......................... 1,682 1.4

Laxatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 639 0.5

Antidiarrheal agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 0.2

Other ............................................. * *

Skin/mucous membrane ................................... 3,988 3.4

Dermatologics ........................................ 3,029 2.6

Antiseptics/disinfectants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265 0.2

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 694 0.4

Immunologic agents ..................................... 3,726 3.2

Vaccines and antiserum .................................. 3,673 3.1

Other ............................................. * *

Hormones and related agents ............................... 3,556 3.0

Adrenal corticosteroids .................................. 1,813 1.5

Blood glucose regulators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 957 0.8

Agents used to treat thyroid disease . . . . . . . . . . . . . . . . . . . . . . . . . . 256 0.2

Estrogens and progestins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235 0.2

Contraceptive agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184 0.2

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 0.1

Neurologic drugs ....................................... 2,774 2.4

Anesthetic drugs ........................................ 2,755 2.3

Metabolic and nutrient agents ............................... 2,336 2.0

Ophthalmic drugs ....................................... 2,094 1.8

Hematologic agents ...................................... 1,192 1.0

Otologic drugs ......................................... 1,127 1.0

Other and unclassified2 ................................... 6,870 5.9

* Figure does not meet standard of reliability or precision. 1Therapeutic classification is based on the standard drug classification used in the National Drug Code Directory, 1985 Edition (12).

2Includes antidotes, radiopharmaceuticals/contrast media, oncolytics, antiparasitics, and unclassified or miscellaneous drugs.

NOTE: Numbers may not add to totals because of rounding.

54
Table 29. Number and percent distribution of drug mentions at emergency department visits by therapeutic classification, according to

patient’s age, sex, and race: United States, 1992

Therapeutic classification1

Age Sex Race2

All

ages

Under

15 years

15–24

years

25–44

years

45–64

years

65–74

years

75 years

and over Female Male White Black

Number of drug mentions in thousands

All drug mentions ........................ 117,419 25,441 16,890 36,196 19,772 9,253 9,866 63,296 54,123 92,797 21,975

Drugs used for relief of pain ................. 34,993 7,333 5,815 12,622 5,484 1,963 1,776 18,597 16,396 27,720 6,521

Antimicrobial agents ...................... 19,576 7,395 3,345 5,239 1,980 717 899 10,327 9,249 14,510 4,632

Respiratory tract drugs ..................... 13,348 4,404 1,787 3,502 2,051 880 724 7,402 5,946 10,217 2,763

Cardiovascular-renal drugs .................. 7,585 101 75 1,007 2,245 1,882 2,274 4,339 3,246 6,215 1,276

Psychopharmacological drugs ................ 5,934 417 713 2,407 1,343 577 477 3,682 2,252 5,175 635

Gastrointestinal agents ..................... 5,565 504 862 1,923 1,150 519 607 3,330 2,236 4,476 936

Skin/mucous membrane .................... 3,988 1,372 627 1,172 390 226 201 1,737 2,251 3,111 771

Immunologic agents ...................... 3,726 362 776 1,427 638 232 291 1,565 2,160 3,113 541

Hormones and related agents ................ 3,556 632 398 952 794 380 401 2,274 1,281 2,792 669

Neurologic drugs ........................ 2,774 106 439 1,463 463 128 174 1,278 1,496 2,227 494

Anesthetic drugs ......................... 2,755 320 235 611 602 471 517 1,325 1,430 2,371 316

Metabolic and nutrient agents ................ 2,336 347 195 537 525 365 368 1,324 1,012 1,864 390

Ophthalmic drugs ........................ 2,094 590 383 783 205 * 88 836 1,259 1,719 337

Hematologic agents ....................... 1,192 * * 239 387 200 265 656 537 1,034 136

Otologic drugs .......................... 1,127 387 131 266 159 98 86 694 433 935 167

Other and unclassified3 .................... 6,870 1,117 1,063 2,047 1,357 570 717 3,931 2,939 5,317 1,390

Percent distribution

All drug mentions ........................ 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Drugs used for relief of pain ................. 29.8 28.8 34.4 34.9 27.7 21.2 18.0 29.4 30.3 29.9 29.7

Antimicrobial agents ...................... 16.7 29.1 19.8 14.5 10.0 7.7 9.1 16.3 17.1 15.6 21.1

Respiratory tract drugs . . . . . . . . . . . . . . . . . . . . . 11.4 17.3 10.6 9.7 10.4 9.5 7.3 11.7 11.0 11.0 12.6

Cardiovascular-renal drugs . . . . . . . . . . . . . . . . . . 6.5 0.4 0.4 2.8 11.4 20.3 23.1 6.9 6.0 6.7 5.8

Psychopharmacological drugs . . . . . . . . . . . . . . . . 5.1 1.6 4.2 6.7 6.8 6.2 4.8 5.8 4.2 5.6 2.9

Gastrointestinal agents . . . . . . . . . . . . . . . . . . . . . 4.7 2.0 5.1 5.3 5.8 5.6 6.2 5.3 4.1 4.8 4.3

Skin/mucous membrane . . . . . . . . . . . . . . . . . . . . 3.4 5.4 3.7 3.2 2.0 2.4 2.0 2.7 4.2 3.4 3.5

Immunologic agents . . . . . . . . . . . . . . . . . . . . . . 3.2 1.4 4.6 3.9 3.2 2.5 3.0 2.5 4.0 3.4 2.5

Hormones and related agents . . . . . . . . . . . . . . . . 3.0 2.5 2.4 2.6 4.0 4.1 4.1 3.6 2.4 3.0 3.0

Neurologic drugs . . . . . . . . . . . . . . . . . . . . . . . . 2.4 0.4 2.6 4.0 2.3 1.4 1.8 2.0 2.8 2.4 2.2

Anesthetic drugs . . . . . . . . . . . . . . . . . . . . . . . . . 2.3 1.3 1.4 1.7 3.0 5.1 5.2 2.1 2.6 2.6 1.4

Metabolic and nutrient agents . . . . . . . . . . . . . . . . 2.0 1.4 1.2 1.5 2.7 3.9 3.7 2.1 1.9 2.0 1.8

Ophthalmic drugs . . . . . . . . . . . . . . . . . . . . . . . . 1.8 2.3 2.3 2.2 1.0 * 0.9 1.3 2.3 1.9 1.5

Hematologic agents . . . . . . . . . . . . . . . . . . . . . . . 1.0 * * 0.7 2.0 2.2 2.7 1.0 1.0 1.1 0.6

Otologic drugs . . . . . . . . . . . . . . . . . . . . . . . . . . 1.0 1.5 0.8 0.7 0.8 1.1 0.9 1.1 0.8 1.0 0.8

Other and unclassified3 . . . . . . . . . . . . . . . . . . . . 5.9 4.4 6.3 5.7 6.9 6.2 7.3 6.2 5.4 5.7 6.3

* Figure does not meet standard of reliability or precision.

1Therapeutic classification is based on the standard drug classification used in the National Drug Code Directory, 1985 Edition (12).

2Estimates for races other than white and black have been omitted because of small sample sizes.

3Includes antidotes, radiopharmaceuticals/contrast media, oncolytics, antiparasitics, and unclassified/miscellaneous drugs.

NOTE: Numbers may not add to totals because of rounding.

55
Table 30. Number and percent distribution of drug mentions at emergency department visits by patient’s age, sex, and race, according

to therapeutic classification of drug: United States, 1992

Therapeutic classification1

Number

of drug

mentions

in thousands

Age Sex Race2

Total

Under

15 years

15–24

years

25–44

years

45–64

years

65–74

years

75 years

and over Female Male White Black

Percent distribution

All drug mentions ........................ 117,419 100.0 21.7 14.4 30.8 16.8 7.9 8.4 53.9 46.1 79.0 18.7

Drugs used for relief of pain ................. 34,993 100.0 21.0 16.6 36.1 15.7 5.6 5.1 53.1 46.9 79.2 18.6

Antimicrobial agents ...................... 19,576 100.0 37.8 17.1 26.8 10.1 3.7 4.6 52.8 47.2 74.1 23.7

Respiratory tract drugs ..................... 13,348 100.0 33.0 13.4 26.2 15.4 6.6 5.4 55.5 44.5 76.5 20.7

Cardiovascular-renal drugs .................. 7,585 100.0 1.3 1.0 13.3 29.6 24.8 30.0 57.2 42.8 81.9 16.8

Psychopharmacological drugs ................ 5,934 100.0 7.0 12.0 40.6 22.6 9.7 8.0 62.0 38.0 87.2 10.7

Gastrointestinal agents ..................... 5,565 100.0 9.1 15.5 34.5 20.7 9.3 10.9 59.8 40.2 80.4 16.8

Skin/mucous membrane .................... 3,988 100.0 34.4 15.7 29.4 9.8 5.7 5.0 43.6 56.4 78.0 19.3

Immunologic agents ...................... 3,726 100.0 9.7 20.8 38.3 17.1 6.2 7.8 42.0 58.0 83.6 14.5

Hormones and related agents ................ 3,556 100.0 17.8 11.2 26.8 22.3 10.7 11.3 64.0 36.0 78.5 18.8

Neurologic drugs ........................ 2,774 100.0 3.8 15.8 52.8 16.7 4.6 6.3 46.1 53.9 80.3 17.8

Anesthetic drugs ......................... 2,755 100.0 11.6 8.5 22.2 21.9 17.1 18.8 48.1 51.9 86.0 11.5

Metabolic and nutrient agents ................ 2,336 100.0 14.8 8.3 23.0 22.5 15.6 15.8 56.7 43.3 79.8 16.7

Ophthalmic drugs ........................ 2,094 100.0 28.2 18.3 37.4 9.8 * 4.2 39.9 60.1 82.1 16.1

Hematologic agents ....................... 1,192 100.0 * * 20.0 32.4 16.8 22.2 55.0 45.0 86.7 11.4

Otologic drugs .......................... 1,127 100.0 34.3 11.7 23.6 14.1 8.7 7.6 61.6 38.4 83.0 14.8

Other and unclassified3 .................... 6,870 100.0 16.3 15.5 29.8 19.8 8.3 10.4 57.2 42.8 77.4 20.2

* Figure does not meet standard of reliability or precision.

1Therapeutic classification is based on the standard drug classification used in the National Drug Code Directory, 1985 Edition (12).

2Estimates for races other than white and black have been omitted because of small sample sizes.

3Includes antidotes, radiopharmaceuticals/contrast media, oncolytics, antiparasitics, and unclassified/miscellaneous drugs.

NOTE: Numbers may not add to totals because of rounding.

56
Table 31. Number and percent distribution of emergency department visits by medication therapy, according to selected principal

diagnoses: United States, 1992

Principal diagnosis and ICD–9–CM code2

Number of

visits in

thousands

Medication therapy1

Total Yes No

Percent distribution

All visits ................................................. 89,796 100.0 69.1 30.9

Infectious and parasitic diseases ............................ 001–139 3,113 100.0 78.0 22.0

Viral infection in conditions classified elsewhere and of unspecified site . . . . . . 079 876 100.0 78.9 21.1

Neoplasms ......................................... 140–239 254 100.0 61.7 38.3

Endocrine, nutritional and metabolic diseases, and immunity disorders .... 240–279 1,087 100.0 68.8 31.2

Mental disorders ...................................... 290–319 2,381 100.0 51.5 48.5

Diseases of the nervous system and sense organs ................ 320–389 6,026 100.0 88.3 11.7

Disorders of conjunctiva . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 372 551 100.0 83.7 16.3

Suppurative and unspecified otitis media . . . . . . . . . . . . . . . . . . . . . . . . . 382 3,162 100.0 93.8 6.2

Diseases of the circulatory system .......................... 390–459 3,875 100.0 70.0 30.0

Diseases of the respiratory system .......................... 460–519 10,905 100.0 85.1 14.9

Acute pharyngitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 462 1,260 100.0 84.5 15.5

Acute upper respiratory infections of multiple or unspecified sites . . . . . . . . . . 465 1,998 100.0 80.0 20.0

Pneumonia, organism unspecified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 486 1,142 100.0 77.0 23.0

Bronchitis, not specified as acute or chronic . . . . . . . . . . . . . . . . . . . . . . . 490 1,041 100.0 89.5 10.5

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493 1,467 100.0 94.9 5.1

Diseases of the digestive system ........................... 520–579 5,469 100.0 69.1 30.9

Other noninfectious gastroenteritis and colitis . . . . . . . . . . . . . . . . . . . . . . 558 1,805 100.0 66.4 33.6

Diseases of the genitourinary system ......................... 580–629 3,810 100.0 77.1 22.9

Other disorders of urethra and urinary tract . . . . . . . . . . . . . . . . . . . . . . . . 599 1,340 100.0 80.7 19.3

Diseases of the skin and subcutaneous tissue ................... 680–709 2,666 100.0 78.9 21.1

Diseases of the musculoskeletal system and connective tissue ......... 710–739 3,812 100.0 78.9 21.1

Other and unspecified disorders of back . . . . . . . . . . . . . . . . . . . . . . . . . . 724 991 100.0 84.7 15.3

Other disorders of soft tissues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 729 690 100.0 71.8 28.2

Symptoms, signs, and ill-defined conditions ................... 780–799 10,484 100.0 69.7 30.3

General symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 780 2,340 100.0 67.0 33.0

Symptoms involving head and neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . 784 1,244 100.0 80.5 19.5

Symptoms involving respiratory system and other chest symptoms . . . . . . . . . 786 2,667 100.0 74.0 26.0

Other symptoms involving abdomen and pelvis . . . . . . . . . . . . . . . . . . . . . 789 2,353 100.0 66.4 33.6

Injury and poisoning ................................... 800–999 29,389 100.0 64.2 35.8

Sprains and strains of ankle and foot . . . . . . . . . . . . . . . . . . . . . . . . . . . 845 1,357 100.0 52.3 47.7

Sprains and strains of other and unspecified parts of back . . . . . . . . . . . . . . 847 1,829 100.0 74.7 25.3

Other open wound of head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 873 2,578 100.0 57.4 42.6

Open wound of other and unspecified sites, except limbs . . . . . . . . . . . . . . . 879 1,295 100.0 52.1 47.9

Open wound of fingers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 883 1,617 100.0 68.8 31.2

Contusion of upper limb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 923 1,273 100.0 56.6 43.4

Contusion of lower limb and of other and unspecified sites . . . . . . . . . . . . . . 924 1,784 100.0 62.4 37.6

Supplementary classification .............................. V01–V82 3,000 100.0 31.6 68.4

All other diagnoses3 ......................................... 1,227 100.0 48.4 51.6

Unknown4 ................................................ 2,297 100.0 32.1 67.8

1Includes new or continuing medication that was provided or prescribed at the visit.

2Based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM) (11).

3Includes diseases of the blood and blood-forming organs (280–289); complications of pregnancy, childbirth, and the puerperium (630–676); congenital anomalies (740–759); and certain conditions

originating in the perinatal period (760–779).

4Includes blank diagnoses, uncodable diagnoses, and illegible diagnoses.

NOTE: Numbers may not add to totals because of rounding.

57
Table 32. Number and percent of emergency department visits by providers seen and patient’s age, sex, and race: United States, 1992

Provider seen

All

ages

Age Sex Race2

Under

15 years

15–24

years

25–44

years

45–64

years

65–74

years

75 years

and over Female Male White Black

Number of visits in thousands1

All visits .............................. 89,796 22,523 14,848 27,240 12,509 5,806 6,871 46,612 43,184 70,478 17,150

Resident/intern .......................... 12,294 3,899 1,885 3,524 1,560 703 724 6,292 6,002 7,364 4,629

Staff physician .......................... 74,079 18,035 12,304 22,472 10,584 4,878 5,808 38,421 35,658 58,805 13,453

Other physician ......................... 10,535 2,199 1,468 2,877 1,700 984 1,308 5,345 5,190 8,852 1,483

Physician assistant ....................... 1,757 368 381 620 187 97 105 859 898 1,453 271

Nurse practitioner ........................ 1,748 420 289 635 206 113 85 940 808 1,048 673

Registered nurse ........................ 74,635 18,718 12,422 22,592 10,334 4,817 5,752 38,997 35,638 59,256 13,554

Licensed practical nurse .................... 5,837 1,625 1,046 1,737 756 357 316 3,009 2,828 4,249 1,518

Nurse’s aide ........................... 8,494 1,833 1,404 2,553 1,484 653 568 4,454 4,041 6,515 1,891

Percent of visits

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... ... ... ... ... ... ... ... ... ... ...

Resident/intern .......................... 13.7 17.3 12.7 12.9 12.5 12.1 10.5 13.5 13.9 10.4 27.0

Staff physician .......................... 82.5 80.1 82.9 82.5 84.6 84.0 84.5 82.4 82.6 83.4 78.4

Other physician . . . . . . . . . . . . . . . . . . . . . . . . . 11.7 9.8 9.9 10.6 13.6 16.9 19.0 11.5 12.0 12.6 8.6

Physician assistant . . . . . . . . . . . . . . . . . . . . . . . 2.0 1.6 2.6 2.3 1.5 1.7 1.5 1.8 2.1 2.1 1.6

Nurse practitioner . . . . . . . . . . . . . . . . . . . . . . . . 1.9 1.9 1.9 2.3 1.6 1.9 1.2 2.0 1.9 1.5 3.9

Registered nurse ........................ 83.1 83.1 83.7 82.9 82.6 83.0 83.7 83.7 82.5 84.1 79.0

Licensed practical nurse . . . . . . . . . . . . . . . . . . . . 6.5 7.2 7.0 6.4 6.0 6.1 4.6 6.5 6.5 6.0 8.8

Nurse’s aide . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.5 8.1 9.5 9.4 11.9 11.3 8.3 9.6 9.4 9.2 11.0

. . . Category not applicable.

1Numbers do not add to totals because more than one category may be reported per visit.

2Estimates for races other than white and black have been omitted because of small sample sizes.

NOTE: Example of use of table: 17.3 percent of visits by persons under 15 years included being seen by a resident/intern.

58
Table 33. Number and percent of emergency department visits by expected source of payment and patient’s age, sex, and race:

United States, 1992

Expected source of payment

Age Sex Race2

All

ages

Under 15

years

15–24

years

25–44

years

45–64

years

65–74

years

75 years

and over Female Male White Black

Number of visits in thousands1

All visits .............................. 89,796 22,523 14,848 27,240 12,509 5,806 6,871 46,612 43,184 70,478 17,150

Private/commercial insurance ................. 32,331 7,449 4,924 10,042 5,667 1,984 2,265 16,067 16,265 28,340 3,434

Medicaid ............................. 20,339 9,149 3,159 4,918 1,684 628 803 11,939 8,400 13,650 6,137

Medicare ............................. 13,582 243 101 1,081 1,449 4,638 6,071 7,922 5,661 11,809 1,615

Patient paid ............................ 12,402 2,210 3,363 4,975 1,559 158 138 5,778 6,624 8,984 3,038

HMO/other prepaid ....................... 6,566 1,893 974 2,148 987 321 243 3,516 3,050 5,287 1,004

Other government ........................ 4,032 895 686 1,573 653 130 95 1,867 2,165 2,921 889

No charge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 778 198 91 295 167 * * 446 333 367 408

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,117 665 1,466 2,722 926 163 175 2,642 3,475 4,961 983

Unknown ............................. 1,505 355 291 471 241 91 * 845 661 940 541

Percent of visits

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... ... ... ... ... ... ... ... ... ... ...

Private/commercial insurance ................. 36.0 33.1 33.2 36.9 45.3 34.2 33.0 34.5 37.7 40.2 20.0

Medicaid ............................. 22.7 40.6 21.3 18.1 13.5 10.8 11.7 25.6 19.5 19.4 35.8

Medicare ............................. 15.1 1.1 0.7 4.0 11.6 79.9 88.4 17.0 13.1 16.8 9.4

Patient-paid ............................ 13.8 9.8 22.7 18.3 12.5 2.7 2.0 12.4 15.3 12.7 17.7

HMO/other prepaid . . . . . . . . . . . . . . . . . . . . . . . 7.3 8.4 6.6 7.9 7.9 5.5 3.5 7.5 7.1 7.5 5.9

Other government . . . . . . . . . . . . . . . . . . . . . . . . 4.5 4.0 4.6 5.8 5.2 2.2 1.4 4.0 5.0 4.1 5.2

No charge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.9 0.9 0.6 1.1 1.3 * * 1.0 0.8 0.5 2.4

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.8 3.0 9.9 10.0 7.4 2.8 2.5 5.7 8.0 7.0 5.7

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.7 1.6 2.0 1.7 1.9 1.6 * 1.8 1.5 1.3 3.2

. . . Category not applicable.

* Figure does not meet standard of reliability or precision.

1Numbers do not add to totals because more than one expected source of payment may be reported per visit.

2Estimates for races other than white and black have been omitted because of small sample sizes.

NOTE: Example of use of table: 40.6 percent of visits by persons under 15 years included Medicaid as an expected source of payment.

59
Table 34. Number and percent of emergency department visits by disposition of visit and patient’s age, sex, and race: United States, 1992

Disposition

Age Sex Race2

All

ages

Under

15 years

15–24

years

25–44

years

45–64

years

65–74

years

75 years

and over Female Male White Black

Number of visits in thousands1

All visits .............................. 89,796 22,523 14,848 27,240 12,509 5,806 6,871 46,612 43,184 70,478 17,150

Refer to other physician/clinic ................. 33,215 8,465 6,347 11,161 4,296 1,565 1,381 17,303 15,912 24,844 7,466

Return to ED, PRN ....................... 22,429 6,795 4,053 7,075 2,652 1,008 846 11,695 10,734 17,649 4,267

Return to referring physician .................. 19,030 5,420 2,989 5,601 2,610 1,183 1,227 10,430 8,600 15,974 2,683

Admit to hospital ......................... 12,110 1,154 847 2,368 2,634 1,952 3,156 6,444 5,666 10,340 1,513

No followup planned ....................... 5,339 1,679 1,031 1,647 569 192 221 2,714 2,626 3,989 1,218

Return to ED, appointment ................... 4,322 1,213 872 1,354 564 166 152 1,796 2,526 3,251 1,002

Transfer to other facility ..................... 1,093 114 149 331 164 161 175 535 558 877 192

Left AMA .............................. 1,047 196 177 449 178 * * 497 550 657 367

DOA/died in ED . . . . . . . . . . . . . . . . . . . . . . . . . 282 * * * * * 126 114 169 245 *

Other ................................ 4,589 1,159 756 1,559 590 218 308 2,279 2,310 3,497 903

Percent of visits

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... ... ... ... ... ... ... ... ... ... ...

Refer to other physician/clinic ................. 37.0 37.6 42.7 41.0 34.3 26.9 20.1 37.1 36.8 35.3 43.5

Return to ED, PRN ....................... 25.0 30.2 27.3 26.0 21.2 17.4 12.3 25.1 24.9 25.0 24.9

Return to referring physician .................. 21.2 24.1 20.1 20.6 20.9 20.4 17.9 22.4 19.9 22.7 15.6

Admit to hospital ......................... 13.5 5.1 5.7 8.7 21.1 33.6 45.9 13.8 13.1 14.7 8.8

No followup planned . . . . . . . . . . . . . . . . . . . . . . . 5.9 7.5 6.9 6.0 4.5 3.3 3.2 5.8 6.1 5.7 7.1

Return to ED, appointment . . . . . . . . . . . . . . . . . . . 4.8 5.4 5.9 5.0 4.5 2.9 2.2 3.9 5.8 4.6 5.8

Transfer to other facility . . . . . . . . . . . . . . . . . . . . . 1.2 0.5 1.0 1.2 1.3 2.8 2.5 1.1 1.3 1.2 1.1

Left AMA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.2 0.9 1.2 1.6 1.4 * * 1.1 1.3 0.9 2.1

DOA/died in ED . . . . . . . . . . . . . . . . . . . . . . . . . 0.3 * * * * * 1.8 0.2 0.4 0.3 *

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1 5.1 5.1 5.7 4.7 3.7 4.5 4.9 5.3 5.0 5.3

. . . Category not applicable.

* Figure does not meet standard of reliability or precision.

1Numbers do not add to totals because more than one disposition may be reported per visit.

2Estimates for races other than white and black have been omitted because of small sample sizes.

NOTES: ED is emergency department, PRN is pro re nata, as needed, AMA is against medical advice, and DOA is dead on arrival.

Example of use of table: 33.6 percent of visits by persons 65–74 years resulted in hospital admission.

60
Table 35. Number and percent distribution of emergency department visits by facility ownership, according to location and patient’s

race: United States, 1992

Facility ownership

All areas Metropolitan area1 Nonmetropolitan area1

All races2 White Black All races2 White Black All races2 White Black

Number of visits in thousands

All visits .................. 89,796 70,478 17,150 70,978 53,348 15,791 18,817 17,130 1,359

Voluntary, nonprofit ........... 59,058 47,113 10,410 46,681 35,798 9,608 12,377 11,315 802

Non-Federal government ....... 11,763 7,511 3,996 8,742 4,926 3,598 3,021 2,585 398

Proprietary ................ 18,974 15,853 2,743 15,555 12,624 2,584 3,419 3,229 159

Percent distribution

All visits .................. 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Voluntary, nonprofit ........... 65.8 66.8 60.7 65.8 67.1 60.8 65.8 66.1 59.0

Non-Federal government ....... 13.1 10.7 23.3 12.3 9.2 22.8 16.1 15.1 29.3

Proprietary ................ 21.1 22.5 16.0 21.9 23.7 16.4 18.2 18.9 11.7

Number of visits per 1,000 persons per year3

All visits .................. 357.1 336.5 545.1 361.0 331.5 592.0 343.1 353.0 283.9

Voluntary, nonprofit ........... 234.9 224.9 330.9 237.4 222.4 360.2 225.7 233.2 167.6

Non-Federal government ....... 46.8 35.9 127.0 44.5 30.6 134.9 55.1 53.3 83.1

Proprietary ................ 75.5 75.7 87.2 79.1 78.4 96.9 62.3 66.6 33.3

1Based on U.S. Bureau of the Census designations.

2Races other than white and black are not shown separately because of small sample sizes but are included in totals.

3Based on U.S. Bureau of the Census estimates of the civilian, noninstitutional population as of July 1, 1992.

NOTE: Numbers may not add to totals because of rounding.

61
Table 36. Number and percent of emergency department visits by expected source of payment and facility ownership: United States, 1992

Expected source of payment All visits

Facility ownership

Voluntary,

nonprofit

Non-Federal

government Proprietary

Number of visits in thousands1

All visits .............................. 89,796 59,058 11,763 18,974

Private/commercial insurance ................. 32,331 23,269 2,457 6,605

Medicaid .............................. 20,339 13,391 3,093 3,855

Medicare .............................. 13,582 8,971 1,684 2,927

Patient-paid ............................ 12,402 7,094 2,548 2,761

HMO/other prepaid2 ....................... 6,566 3,885 482 2,199

Other government ........................ 4,032 2,970 392 671

No charge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 778 119 613 *

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,117 4,141 803 1,172

Unknown ............................. 1,505 592 666 248

Percent of visits

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... ... ... ...

Private/commercial insurance ................. 36.0 39.4 20.9 34.8

Medicaid .............................. 22.7 22.7 26.3 20.3

Medicare .............................. 15.1 15.2 14.3 15.4

Patient-paid ............................ 13.8 12.0 21.7 14.6

HMO/other prepaid2 . . . . . . . . . . . . . . . . . . . . . . . 7.3 6.6 4.1 11.6

Other government . . . . . . . . . . . . . . . . . . . . . . . . 4.5 5.0 3.3 3.5

No charge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.9 0.2 5.2 *

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.8 7.0 6.8 6.2

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.7 1.0 5.7 1.3

* Figure does not meet standard of reliability or precision.

. . . Category not applicable.

1Numbers do not add to totals because more than one expected source of payment may be reported per visit.

2HMO is health maintenance organization.

NOTE: Example of use of table: 26.3 percent of emergency department visits to government-owned hospitals (excluding Federal) included Medicaid as an expected source of payment.

62
Table 37. Number and percent of emergency department visits by disposition of visit and facility ownership: United States, 1992

Disposition All visits

Facility ownership

Voluntary,

nonprofit

Non-Federal

government Proprietary

Number of visits in thousands1

All visits .............................. 89,796 59,058 11,763 18,974

Refer to other physician/clinic ................. 33,215 20,728 4,679 7,808

Return to ED, PRN ....................... 22,429 14,376 3,397 4,656

Return to referring physician ................. 19,030 14,268 1,043 3,719

Admit to hospital ......................... 12,110 8,290 1,337 2,483

No followup planned ...................... 5,339 3,430 973 936

Return to ED, appointment .................. 4,322 2,409 975 937

Transfer to other facility .................... 1,093 647 203 242

Left AMA ............................. 1,047 522 263 262

DOA/died in ED . . . . . . . . . . . . . . . . . . . . . . . . . 282 143 * *

Other ................................ 4,589 3,306 534 749

Percent of visits

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... ... ... ...

Refer to other physician/clinic ................. 37.0 35.1 39.8 41.2

Return to ED, PRN ....................... 25.0 24.3 28.9 24.5

Return to referring physician ................. 21.2 24.2 8.9 19.6

Admit to hospital ......................... 13.5 14.0 11.4 13.1

No followup planned . . . . . . . . . . . . . . . . . . . . . . 5.9 5.8 8.3 4.9

Return to ED, appointment . . . . . . . . . . . . . . . . . . 4.8 4.1 8.3 4.9

Transfer to other facility . . . . . . . . . . . . . . . . . . . . 1.2 1.1 1.7 1.3

Left AMA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.2 0.9 2.2 1.4

DOA/died in ED . . . . . . . . . . . . . . . . . . . . . . . . . 0.3 0.2 * *

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1 5.6 4.5 3.9

* Figure does not meet standard of reliability or precision.

. . . Category not applicable.

1Numbers do not add to totals because more than one disposition may be reported per visit.

NOTES: ED is emergency department, PRN is pro re nata, as needed, AMA is against medical advice, and DOA is dead on arrival.

Example of use of table: 8.3 percent of visits to emergency departments of government-owned hospitals (excluding Federal) included instructions for a scheduled return appointment.

63
Table 38. Number, percent, and annual rate of emergency department visits by urgency of visit and patient’s age, sex, and race:

United States, 1992

Patient characteristic All visits

Number of

urgent

visits in

thousands1

Percent of

urgent

visits2

Number of

urgent

visits per

1,000 persons

per year3

Number of

nonurgent

visits in

thousands4

Percent of

nonurgent

visits5

Number of

nonurgent

visits per

1,000 persons

per year3

All visits .............................. 89,796 40,078 44.6 159.4 49,718 55.4 197.7

Age

Under 15 years ......................... 22,523 8,874 39.4 157.2 13,649 60.6 241.8

15–24 years ........................... 14,848 5,800 39.1 168.7 9,048 60.9 263.1

25–44 years ........................... 27,240 11,080 40.7 136.2 16,160 59.3 198.7

45–64 years ........................... 12,509 6,379 51.0 131.5 6,131 49.0 126.4

65–74 years ........................... 5,806 3,434 59.2 185.9 2,371 40.8 128.4

75 years and over ........................ 6,871 4,513 65.7 366.3 2,358 34.3 191.4

Sex and age

Female .............................. 46,612 20,338 43.6 157.3 26,275 56.4 203.3

Under 15 years ........................ 10,196 3,842 37.7 139.5 6,353 62.3 230.6

15–24 years .......................... 8,051 2,992 37.2 173.1 5,059 62.8 292.7

25–44 years .......................... 14,045 5,573 39.7 134.8 8,472 60.3 205.0

45–64 years .......................... 6,629 3,159 47.7 125.4 3,471 52.4 137.8

65–74 years .......................... 3,350 1,943 58.0 190.6 1,407 42.0 138.0

75 years and over ...................... 4,342 2,829 65.2 367.2 1,513 34.8 196.4

Male ................................ 43,184 19,741 45.7 161.6 23,443 54.3 191.9

Under 15 years ........................ 12,327 5,031 40.8 174.1 7,296 59.2 252.5

15–24 years .......................... 6,797 2,807 41.3 164.2 3,990 58.7 233.4

25–44 years .......................... 13,195 5,506 41.7 137.7 7,689 58.3 192.2

45–64 years .......................... 5,880 3,220 54.8 138.2 2,660 45.2 114.1

65–74 years .......................... 2,456 1,492 60.7 180.3 964 39.3 116.5

75 years and over ...................... 2,529 1,684 66.6 364.7 845 33.4 183.0

Race and age6

White ............................... 70,478 32,097 45.5 153.2 38,381 54.5 183.2

Under 15 years ........................ 16,878 6,629 39.3 147.4 10,250 60.7 227.9

15–24 years .......................... 11,598 4,662 40.2 169.7 6,936 59.8 252.4

25–44 years .......................... 20,579 8,473 41.2 125.1 12,106 58.8 178.8

45–64 years .......................... 10,134 5,206 51.4 124.7 4,928 48.6 118.1

65–74 years .......................... 5,017 2,997 59.7 182.9 2,020 40.3 123.3

75 years and over ...................... 6,272 4,131 65.9 370.4 2,141 34.1 192.0

Black ................................ 17,150 7,158 41.7 227.5 9,992 58.3 317.6

Under 15 years ........................ 5,132 2,087 40.7 233.1 3,045 59.3 340.0

15–24 years .......................... 2,877 1,030 35.8 202.0 1,847 64.2 362.2

25–44 years .......................... 5,840 2,271 38.9 231.8 3,569 61.1 364.4

45–64 years . . . . . . . . . . . . . . . . . . . . . . . . . . 2,111 1,035 49.0 207.4 1,076 51.0 215.7

65–74 years . . . . . . . . . . . . . . . . . . . . . . . . . . 685 396 57.8 240.9 289 42.2 175.8

75 years and over . . . . . . . . . . . . . . . . . . . . . . 505 339 67.1 346.6 166 32.9 169.7

1Visits were reported to be urgent by hospital staff based on the following definition: immediate attention is required for an acute illness or injury that threatens life or function and where delay

would be harmful to the patient.

2Percent of all visits in each category that were considered urgent by hospital staff.

3Based on U.S. Bureau of the Census estimates of the civilian noninstitutionalized population of the United States as of July 1, 1992.

4Visits were reported to be nonurgent by hospital staff based on the following definition: patient does not require attention immediately or within a few hours.

5Percent of visits in each category that were considered nonurgent by hospital staff.

6Estimates for races other than white and black have been omitted because of small sample sizes.

NOTE: Numbers may not add to totals because of rounding.

64
Table 39. Number, percent distribution, and annual rate of emergency department visits by urgency of visit, according to major reason

for visit: United States, 1992

Major reason for visit All visits

Urgency of visit

Urgent Nonurgent

Number of visits in thousands

All visits ............................................. 89,796 40,078 49,717

Illness related1 ......................................... 50,931 22,528 28,403

First visit ........................................... 48,224 21,635 26,588

Followup ........................................... 2,707 893 1,814

Injury related2 ......................................... 33,950 15,701 18,249

First visit ........................................... 29,856 14,671 15,185

Followup ........................................... 3,308 540 2,767

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 787 490 297

Other reason3 ......................................... 3,872 1,410 2,463

Blank or invalid ........................................ 1,043 439 603

Percent distribution

All visits ............................................. 100.0 44.6 55.4

Illness related1 ......................................... 100.0 44.2 55.8

First visit ........................................... 100.0 44.9 55.1

Followup ........................................... 100.0 33.0 67.0

Injury related2 ......................................... 100.0 46.2 53.8

First visit ........................................... 100.0 49.1 50.9

Followup ........................................... 100.0 16.3 83.6

Unknown ........................................... 100.0 62.2 37.7

Other reason3 ......................................... 100.0 36.4 63.6

Blank or invalid ........................................ 100.0 42.1 57.9

Number of visits per 1,000 persons4

All visits ............................................. 357.1 159.4 197.7

Illness related1 ......................................... 202.6 89.6 113.0

First visit ........................................... 191.8 86.0 105.7

Followup ........................................... 10.8 3.6 7.2

Injury related2 ......................................... 135.0 62.4 72.6

First visit ........................................... 118.7 58.3 60.4

Followup ........................................... 13.2 2.1 11.0

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.1 1.9 1.2

Other reason3 ......................................... 15.4 5.6 9.8

Blank or invalid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.1 1.7 2.4

1Includes visits described as illness related in item 9 of the Patient Record form which did not have a specified cause of injury in item 10.

2Includes all visits described as injury related in item 9 or with a cause of injury specified in item 10. Three percent of the 52,528,000 visits described as illness related in item 9 reported a cause

of injury in item 10, and 14 percent of the 5,701,000 visits made for other or unspecified reasons in item 9 reported a cause of injury in item 10.

3Other reasons include preadmission examination. First or followup visit status was not collected for these visits.

4Based on U.S. Bureau of the Census estimates of the civilian noninstitutionalized population of the United States as of July 1, 1992.

NOTE: Numbers may not add to totals because of rounding.

65
Table 40. Number and percent distribution of emergency department visits by urgency of visit, according to selected principal reasons

for visit: United States, 1992

Principal reason for visit and RVC code1

Number of

visits in

thousands

Urgency of visit

Total Urgent Nonurgent

Percent distribution

All visits .......................................... 89,796 100.0 44.6 55.4

Stomach and abdominal pain, cramps and spasms ........... S545 4,955 100.0 47.5 52.5

Chest pain and related symptoms (not referable to

body system) .................................. S050 4,625 100.0 74.0 26.0

Fever ....................................... S010 3,678 100.0 38.1 61.9

Headache, pain in head ............................ S210 2,545 100.0 35.5 64.5

Lacerations and cuts of upper extremity ................... J225 2,347 100.0 50.7 49.3

Shortness of breath ............................... S415 2,025 100.0 75.9 24.1

Cough ....................................... S440 1,997 100.0 29.6 70.4

Back symptoms ................................. S905 1,959 100.0 36.2 63.8

Symptoms referable to throat ......................... S455 1,957 100.0 19.6 80.4

Vomiting ...................................... S530 1,877 100.0 49.5 50.5

Pain, site not referable to specific body system .............. S055 1,812 100.0 42.6 57.4

Earache or ear infection ............................ S355 1,614 100.0 20.7 79.3

Lacerations and cuts of facial area ...................... J210 1,485 100.0 57.8 42.2

Hand and finger symptoms .......................... S960 1,390 100.0 27.0 73.0

Neck symptoms ................................. S900 1,325 100.0 39.3 60.7

Skin rash ..................................... S860 1,305 100.0 20.3 79.7

Labored or difficult breathing (dyspnea) .................. S420 1,239 100.0 71.6 28.4

Leg symptoms .................................. S920 1,154 100.0 40.5 59.5

Knee symptoms ................................. S925 1,102 100.0 30.5 69.5

Head, neck, and face injury, type unspecified ................ J505 1,078 100.0 56.8 43.2

Low back symptoms .............................. S910 1,061 100.0 28.6 71.4

Head cold, upper respiratory infection (coryza) .............. S445 751 100.0 25.5 74.5

Asthma ...................................... D625 613 100.0 75.5 24.5

Wheezing ..................................... S425 486 100.0 82.0 18.0

All other reasons .................................... 45,417 100.0 43.8 56.3

1Based on A Reason for Visit Classification for Ambulatory Care (RVC) (10).

NOTE: Numbers may not add to totals because of rounding.

66
Table 41. Number, percent distribution, and annual rate of emergency department visits by urgency of visit and the 25 principal reasons

for visit most often mentioned by patients: United States, 1992

Rank Reason for visit and RVC code1

Number of

visits in

thousands

Percent

distribution

Number of

visits per

1,000 persons

per year2

Urgent visits

. . . All visits ................................................. 40,078 100.0 159.4

1 Chest pain and related symptoms (not referable to body system) ........... S050 3,424 8.5 13.6

2 Stomach and abdominal pain, cramps, and spasms ................... S545 2,354 5.9 9.4

3 Shortness of breath ....................................... S415 1,538 3.8 6.1

4 Fever ............................................... S010 1,400 3.5 5.6

5 Lacerations and cuts of upper extremity .......................... J225 1,191 3.0 4.7

6 Vomiting .............................................. S530 929 2.3 3.7

7 Headache, pain in head .................................... S210 904 2.3 3.6

8 Labored or difficult breathing (dyspnea) .......................... S420 886 2.2 3.5

9 Lacerations and cuts of facial area ............................. J210 857 2.1 3.4

10 Pain, site not referable to specific body system ...................... S055 771 1.9 3.1

11 Back symptoms ......................................... S905 709 1.8 2.8

12 Convulsions ........................................... S205 625 1.6 2.5

13 Head, neck, and face injury, type unspecified ....................... J505 613 1.5 2.4

14 Cough ............................................... S440 592 1.5 2.4

15 Unconscious on arrival ..................................... J840 583 1.5 2.3

16 Vertigo-dizziness ........................................ S225 573 1.4 2.3

17 Neck symptoms ......................................... S900 521 1.3 2.1

18 Leg symptoms .......................................... S920 467 1.2 1.9

19 Asthma .............................................. D625 462 1.2 1.8

20 Lacerations and cuts of the head and neck area ..................... J205 462 1.2 1.8

21 Accident, not otherwise specified .............................. J810 437 1.1 1.7

22 Hand and finger(s) injury, type unspecified ......................... J570 429 1.1 1.7

23 Abnormal pulsations and palpitations ............................ S260 407 1.0 1.6

24 Arm symptoms .......................................... S945 399 1.0 1.6

25 Wheezing ............................................. S425 299 0.7 1.2

. . . All other reasons ........................................... 18,246 45.5 72.6

Nonurgent visits

. . . All visits ................................................. 49,717 100.0 197.7

1 Stomach and abdominal pain, cramps, and spasms ................... S545 2,601 5.2 10.3

2 Fever ............................................... S010 2,277 4.6 9.1

3 Headache, pain in head .................................... S210 1,641 3.3 6.5

4 Symptoms referable to throat ................................. S455 1,573 3.2 6.3

5 Cough ............................................... S440 1,405 2.8 5.6

6 Earache or ear infection .................................... S355 1,280 2.6 5.1

7 Back symptoms ......................................... S905 1,250 2.5 5.0

8 Chest pain and related symptoms (not referable to body system) ........... S050 1,201 2.4 4.8

9 Lacerations and cuts of upper extremity .......................... J225 1,156 2.3 4.6

10 Pain, site not referable to specific body system ...................... S055 1,040 2.1 4.1

11 Skin rash ............................................. S860 1,040 2.1 4.1

12 Hand and finger symptoms .................................. S960 1,014 2.0 4.0

13 Vomiting .............................................. S530 948 1.9 3.8

14 Neck symptoms ......................................... S900 804 1.6 3.2

15 Knee symptoms ......................................... S925 766 1.5 3.0

16 Foot and toe symptoms .................................... S935 761 1.5 3.0

17 Low back symptoms ...................................... S910 757 1.5 3.0

18 Suture-insertion, removal ................................... T555 725 1.5 2.9

19 Leg symptoms .......................................... S920 687 1.4 2.7

20 Lacerations and cuts of facial area ............................. J210 627 1.3 2.5

21 Ankle symptoms ......................................... S930 607 1.2 2.4

22 Hand and finger(s) injury, type unspecified ......................... J570 567 1.1 2.3

23 Nausea .............................................. S525 565 1.1 2.2

24 Head cold, upper respiratory infection (coryza) ...................... S445 559 1.1 2.2

25 Shoulder symptoms ....................................... S940 542 1.1 2.2

. . . All other reasons ........................................... 23,323 46.9 92.8

. . . Category not applicable.

1Based on A Reason for Visit Classification for Ambulatory Care (RVC) (10).

2Based on U.S. Bureau of the Census estimates of the civilian noninstitutionalized population of the United States as of July 1, 1992.

NOTE: Numbers may not add to totals because of rounding.

67
Table 42. Number and percent distribution of emergency department visits by urgency of visit, according to selected principal

diagnoses: United States, 1992

Principal diagnosis and ICD–9–CM code1

Number of

visits in

thousands

Urgency of visit

Total Urgent Nonurgent

Percent distribution

All visits ................................................. 89,796 100.0 44.6 55.4

Infectious and parasitic diseases ............................ 001–139 3,113 100.0 29.6 70.4

Viral infection in conditions classified elsewhere and of unspecified site . . . . . . 079 876 100.0 26.5 73.5

Neoplasms ......................................... 140–239 254 100.0 56.4 43.6

Endocrine, nutritional and metabolic diseases, and immunity disorders .... 240–279 1,087 100.0 61.9 38.1

Mental disorders ...................................... 290–319 2,381 100.0 47.0 53.0

Diseases of the nervous system and sense organs ................ 320–389 6,026 100.0 29.3 70.7

Disorders of conjunctiva . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 372 551 100.0 23.9 76.1

Suppurative and unspecified otitis media . . . . . . . . . . . . . . . . . . . . . . . . . 382 3,162 100.0 27.6 72.4

Diseases of the circulatory system .......................... 390–459 3,875 100.0 79.4 20.6

Diseases of the respiratory system .......................... 460–519 10,905 100.0 42.8 57.2

Acute pharyngitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 462 1,260 100.0 14.4 85.6

Acute upper respiratory infections of multiple or unspecified sites . . . . . . . . . . 465 1,998 100.0 27.9 72.1

Pneumonia, organism unspecified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 486 1,142 100.0 63.4 36.6

Bronchitis, not specified as acute or chronic . . . . . . . . . . . . . . . . . . . . . . . 490 1,041 100.0 29.7 70.3

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493 1,467 100.0 71.1 28.9

Diseases of the digestive system ........................... 520–579 5,469 100.0 41.4 58.6

Other noninfectious gastroenteritis and colitis . . . . . . . . . . . . . . . . . . . . . . 558 1,805 100.0 36.0 64.0

Diseases of the genitourinary system ......................... 580–629 3,810 100.0 43.3 56.7

Other disorders of urethra and urinary tract . . . . . . . . . . . . . . . . . . . . . . . . 599 1,340 100.0 43.0 57.0

Diseases of the skin and subcutaneous tissue ................... 680–709 2,666 100.0 25.1 74.9

Diseases of the musculoskeletal system and connective tissue ......... 710–739 3,812 100.0 29.5 70.5

Other and unspecified disorders of back . . . . . . . . . . . . . . . . . . . . . . . . . . 724 991 100.0 24.5 75.5

Other disorders of soft tissues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 729 690 100.0 30.4 69.6

Symptoms, signs, and ill-defined conditions ..................... 780–799 10,484 100.0 55.2 44.8

General symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 780 2,340 100.0 62.1 37.9

Symptoms involving head and neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . 784 1,244 100.0 32.6 67.4

Symptoms involving respiratory system and other chest symptoms . . . . . . . . . 786 2,667 100.0 73.6 26.4

Other symptoms involving abdomen and pelvis . . . . . . . . . . . . . . . . . . . . . 789 2,353 100.0 47.8 52.2

Injury and poisoning ................................... 800–999 29,389 100.0 47.7 52.3

Sprains and strains of ankle and foot . . . . . . . . . . . . . . . . . . . . . . . . . . . 845 1,357 100.0 29.0 71.0

Sprains and strains of other and unspecified parts of back . . . . . . . . . . . . . . 847 1,829 100.0 43.2 56.8

Other open wound of head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 873 2,578 100.0 57.3 42.7

Open wound of other and unspecified sites, except limbs . . . . . . . . . . . . . . . 879 1,295 100.0 41.6 58.4

Open wound of fingers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 883 1,617 100.0 48.0 52.0

Contusion of upper limb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 923 1,273 100.0 34.1 65.9

Contusion of lower limb and of other and unspecified sites . . . . . . . . . . . . . . 924 1,784 100.0 39.7 60.3

Supplementary classification .............................. V01–V82 3,000 100.0 24.0 76.0

All other diagnoses2 ......................................... 1,227 100.0 60.6 39.4

Unknown3 ................................................ 2,297 100.0 32.5 67.5

1Based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM) (11).

2Includes diseases of the blood and blood-forming organs (280–289); complications of pregnancy, childbirth, and the puerperium (630–676); congenital anomalies (740–759); and certain conditions

originating in the perinatal period (760–779).

3Includes blank diagnoses, uncodable diagnoses, and illegible diagnoses.

NOTE: Numbers may not add to totals because of rounding.

68
Table 43. Number and percent of emergency department visits by urgency of visit and providers seen: United States, 1992

Provider seen All visits

Urgency of visit

Urgent Nonurgent

Number of visits in thousands1

All visits .......................................... 89,796 40,078 49,717

Resident/intern ...................................... 12,294 6,264 6,031

Staff physician ...................................... 74,079 34,049 40,031

Other physician ..................................... 10,535 5,525 5,010

Physician assistant ................................... 1,757 710 1,047

Nurse practitioner .................................... 1,748 637 1,111

Registered nurse .................................... 74,635 33,746 40,889

Licensed practical nurse ................................ 5,837 2,065 3,772

Nurse’s aide ....................................... 8,494 4,498 3,996

Percent of visits

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... ... ...

Resident/intern ...................................... 13.7 15.6 12.1

Staff physician ...................................... 82.5 85.0 80.5

Other physician . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.7 13.8 10.1

Physician assistant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.0 1.8 2.1

Nurse practitioner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.9 1.6 2.2

Registered nurse .................................... 83.1 84.2 82.2

Licensed practical nurse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.5 5.2 7.6

Nurse’s aide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.5 11.2 8.0

. . . Category not applicable.

1Numbers do not add to totals because more than one category may be reported per visit.

NOTE: Example of use of table: 15.6 percent of emergency department visits considered urgent by hospital staff were attended by a resident/intern.

69
Appendixes

I. Technical notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

Statistical design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

Data collection and processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

Estimation procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

Reliability of estimates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76

Estimation of standard errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76

Tests of significance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

Population figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

Rounding of numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80

Nonsampling error . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80

II. Definition of terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

Terms relating to the survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

Terms relating to the Patient Record forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

III. Survey instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

Introductory letter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

NHAMCS-101 questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88

NHAMCS-101/U ambulatory unit record . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98

Emergency department Patient Record form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107

Outpatient department Patient Record form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108

Appendix tables

I. Number of hospitals in the National Hospital Ambulatory Medical Care Survey universe and sample by class of

hospital: United States, 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

II. Distribution of hospitals in the National Hospital Ambulatory Medical Care Survey by reporting

period and response status: United States, 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

III. Coefficients appropriate for determining approximate relative standard errors by type of estimate and service area:

National Hospital Ambulatory Medical Care Survey, 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76

IV. Approximate relative standard errors for estimated numbers of emergency department visits: National Hospital

Ambulatory Medical Care Survey, 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

V. Approximate relative standard errors for estimated numbers of drug mentions at emergency department visits:

National Hospital Ambulatory Medical Care Survey, 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

VI. Approximate standard errors of percents of estimated numbers of emergency department visits: National Hospital

Ambulatory Medical Care Survey, 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

VII. Approximate standard errors of percents of estimated numbers of drug mentions at emergency department visits:

National Hospital Ambulatory Medical Care Survey, 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

VIII. Estimates of the civilian noninstitutionalized population by selected demographic characteristics:

United States, 1992. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

IX. Estimates of the civilian noninstitutionalized population by selected demographic characteristics and

geographic region: United States, 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

X. Estimates of the civilian noninstitutionalized population by race and urbanicity: United States, 1992 . . . . . . . . . . . . . . 79

70
Appendix I

Technical notes

This report is based on data collected during the period

December 1991–December 1992 in the National Hospital

Ambulatory Medical Care Survey (NHAMCS), a national

probability sample survey of hospital-based ambulatory care

conducted by the Division of Health Care Statistics of the

National Center for Health Statistics, Centers for Disease

Control and Prevention. The NHAMCS survey design and

procedures are presented in the following sections. A detailed

description of the plan and operation of the NHAMCS has

been published (5).

Summary reports and reports on special topics using

NHAMCS data are presented in Series 13 of the NCHS Vital

and Health Statistics series as well as in Advance Data from

Vital and Health Statistics reports. NHAMCS microdata are

also available on public-use tape, CD-ROM and as downloadable data files via the Internet.

Statistical design

Scope of the survey

The target population of the 1992 NHAMCS included

visits to the emergency and outpatient departments of noninstitutional general and short-stay hospitals, exclusive of Federal, military, and Veterans Administration hospitals, located in

the 50 States and the District of Columbia. The NHAMCS was

designed to provide estimates based on the following categories: United States, region, emergency and outpatient departments, and type of ownership.

Sample design

The NHAMCS utilizes a four-stage survey design that

involves probability samples of primary sampling units (PSU’s),

hospitals within PSU’s, outpatient clinics and emergency

service areas within hospitals, and patient visits within outpatient clinics and emergency service areas. The first-stage

sample consisted of 112 PSU’s that comprised a probability

subsample of PSU’s used in the 1985–94 National Health

Interview Survey (NHIS). A PSU is a county, a group of

counties or county equivalents (such as parishes or independent cities), towns, townships, or minor civil divisions (for

some PSU’s in New England), or a metropolitan statistical

area (MSA). MSA’s were defined by the U.S. Office of

Management and Budget based on the 1980 Census.

The NHAMCS PSU sample included with certainty the

26 NHIS PSU’s with the largest populations. In addition, the

sample included half of the next 26 largest PSU’s and 1 PSU

from each of the 73 PSU strata formed from the remaining

PSU’s for the NHIS sample.

The NHIS PSU sample was selected from approximately

1,900 geographically defined PSU’s that covered the 50 States

and the District of Columbia. The 1,000 PSU’s were stratified

by socioeconomic and demographic variables and then selected

with a probability proportional to their size. Stratification was

done within four geographic regions by MSA or non-MSA

status. Based on data from the 1980 Census of Population, a

computer program was used to minimize the between-PSU

variances for NHIS stratification variables. Because the PSU’s

were selected with a probability proportional to size, the

largest PSU’s in the United States were selected with certainty.

Fifty-two PSU’s were selected and referred to as selfrepresenting PSU’s. The remaining PSU’s, or nonselfrepresenting PSU’s, were combined into 73 strata, and two

PSU’s were selected without replacement and with probability

proportional to the projected 1985 population within each

stratum. For details of the 1985–94 NHIS PSU sample design,

see Massey et al. (26).

The second stage consisted of a probability sample of

hospitals within PSU’s. The sampling frame for the 1992

NHAMCS was compiled from hospitals listed on the April

1991 SMG Hospital Market Database. Hospitals that met any

of the following criteria were eligible for the NHAMCS:

+ Average length of stay for all patients of less than 30 days

(short stay)

+ Medical or surgical specialty

+ Children’s general

Hospitals with any of the following characteristics were

ineligible for the NHAMCS:

+ Federal hospitals

+ Hospital units of institutions

+ Hospitals with fewer than six beds staffed for patient use

The SMG Hospital Market Database contained 6,249

hospitals that met the eligibility criteria. Of these, 5,582

(89 percent) had emergency departments (ED’s) and 5,654 had

outpatient departments (OPD’s) (90 percent).

Hospitals were defined as having an ED if the hospital file

indicated the presence of a unit or if the file indicated a

71
non-zero number of visits to such a unit. A similar rule was

used to define the presence of an OPD.

Hospitals were classified into four groups: those with only an

ED, those with an ED and an OPD, those with only an OPD, and

those with neither an ED nor an OPD. Hospitals in the last group

were considered as a separate stratum, and a small sample (50

hospitals) was selected from this stratum to allow for estimation

to the total universe of eligible hospitals and the opening and

closing of ED’s and OPD’s in the sample hospitals.

All hospitals in noncertainty PSU’s with five or fewer

hospitals were selected with certainty. There were 149 hospitals in 55 PSU’s in this category. In noncertainty PSU’s with

more than five hospitals, hospitals were stratified by hospital

class; type of ownership (not-for-profit, non-Federal government, and for-profit); and hospital size. Hospital size was

measured by the combined volume of ED and OPD visits.

From the stratified hospital list, five hospitals were selected in

each PSU with probability proportional to the number of ED

and OPD patient visits. A total of 161 hospitals was selected

from this group.

In the certainty PSU’s, hospitals were stratified by region,

hospital class, ownership, and size. From the stratified hospital

list, 240 hospitals were selected based on probability proportional

to the hospital size. A sample of 50 hospitals was selected from

the 427 hospitals that had neither an ED nor an OPD.

The hospital selections were made so that each hospital

would be chosen only once to avoid multiple inclusion of very

large hospitals. As shown in table I, a fixed panel of 600

hospitals was selected for the NHAMCS sample; 550 hospitals

had an ED and/or an OPD, and 50 hospitals had neither.

To preclude hospitals from participating during the same

time period each year, the sample of 600 hospitals was

randomly divided into 16 subsets of approximately equal size.

Then each of the subsets was assigned to 1 of 16 4-week

reporting periods beginning December 2, 1991. Therefore, the

entire sample does not participate in a given year, and each

hospital is inducted approximately once every 15 months.

The first three reporting periods were originally intended

to be used as a pretest to allow field staff adequate time to

familiarize themselves with the forms and procedures. After

reviewing the data from these reporting periods, NCHS determined that the data were of sufficient quality to be retained.

Hence the 1992 NHAMCS included data collected from

December 2, 1991–December 27, 1992, and consisted of a

sample of 524 hospitals. Subsequent annual samples will

consist of 13 reporting periods in the calendar year. Of the 524

hospitals in the 1992 NHAMCS, 474 were in scope or eligible

to participate in the survey. Ninety-two percent, or 434, of the

eligible facilities participated in the NHAMCS by completing

Patient Record forms. Table II shows 1992 NHAMCS response

rates by reporting period.

The third stage of the sampling process involved outpatient clinics and emergency service areas in hospitals. Within

each hospital, either all outpatient clinics and emergency

service areas or a sample of such units were selected.

To be eligible for the survey, clinics and emergency

service areas must meet the following criteria:

+ Ambulatory medical care is provided under the supervision of a physician and under the the auspices of the

hospital; services are offered at established locations and

schedules.

Clinics and emergency service areas ineligible for the

survey include the following:

+ Those in which only ancillary services are provided;

freestanding clinics, because they are included in the

National Ambulatory Medical Care Survey (NAMCS)

+ Ambulatory surgery centers, whether freestanding or within

the hospital, because they are included in the National Survey

of Ambulatory Surgery, launched in 1994

A list of in-scope and out-of-scope clinics is provided in

appendix II.

The OPD clinic definition excludes the ‘‘hospital as

landlord’’ arrangement in which the hospital only rents space

to a physician group and is not otherwise involved in the

delivery of services. These physicians are considered to be

office based and are currently included in the NAMCS.

However, emergency services provided under the ‘‘hospital as

landlord’’ arrangement are eligible for the NHAMCS. An

emergency department was in scope if it was staffed 24 hours

a day. If an in-scope emergency department had an emergency

service area that was open less than 24 hours a day, that area

was included under the emergency department. If the hospital

had an emergency department that was staffed less than 24

hours a day, it was considered to be an outpatient clinic for

survey purposes.

Hospitals may define the term ‘‘separate clinic’’ differently; for example, by physician location within the hospital,

by staff providing services, by specialty or subspecialty, by

schedules, or by patients’ source of payment. Because of these

differences, ‘‘separate clinics’’ in the NHAMCS were defined

as the smallest administrative units for which the hospital kept

patient volume statistics.

During the visit by a field representative to induct a

hospital into the survey, a list of all emergency service areas

and outpatient clinics was obtained from the sample hospital.

Sampling procedures for outpatient clinics were as follows:

Each outpatient department’s function, specialty, and

expected number of visits during the assigned reporting period

were collected at the induction interview. If there were five or

fewer clinic sampling units, all were included in the survey.

Approximately 20 percent of the hospitals had outpatient

departments with more than five clinics.

Table I. Number of hospitals in the National Hospital Ambulatory

Medical Care Survey universe and sample by class of

hospital: United States, 1992

Hospital class Universe Sample1

Total .................... 6,249 600

Emergency only . . . . . . . . . . . . 168 4

Emergency and outpatient ..... 5414 531

Outpatient only . . . . . . . . . . . . 240 15

Neither . . . . . . . . . . . . . . . . . 427 50

1To preclude hospitals from participating during the same time period each year, the sample

of 600 was randomly divided into 16 subsets. Each subset was assigned to 1 of 16 4-week

reporting periods. Therefore, the entire sample does not participate in a given year. For 1992,

524 hospitals were surveyed between December 2, 1991 and December 27, 1992.

72
If a sample hospital had more than five clinic sampling

units, then five units were randomly selected as follows. The

individual clinics were listed first by five clinic categories:

general medicine, surgery, pediatrics, obstetrics/gynecology,

and other. (During data processing, substance abuse clinics

were removed from the ‘‘other’’ category and placed in a

separate stratum.) A listing of specific clinic types and their

classification is shown in appendix II within the in-scope and

out-of-scope clinic list.

Within each category, clinics were listed in order of clinic

size, from smallest to largest. Clinic size was defined as the

expected number of patient visits during the assigned 4-week

reporting period. Within each clinic group, if a clinic expected

fewer than 30 visits, it was grouped with one or more clinics

to form a sampling unit. Over 90 percent of the clinics were

large enough to form their own sampling unit. After grouping

the clinics into sampling units, five of these units were

selected based on probability proportional to the size of the

sampling unit. If clinic sampling was required, the sampling

was completed by Census headquarters staff in Washington,

D.C. The 1992 NHAMCS included 854 clinics from 314

outpatient departments.

The emergency department was treated as a separate

stratum, and all emergency service areas were selected with

certainty. In the rare instance that a sample hospital had more

than five emergency service areas, a sample of five emergency

service areas was selected with probability proportional to the

expected number of visits to each emergency service area.

Only one hospital in the 1992 NHAMCS reported having

more than five emergency service areas. The 1992 NHAMCS

included 462 emergency service areas from 437 emergency

departments.

The final sample stage was the patient visit. Within

emergency service areas or outpatient department clinics,

patient visits were systemically selected over a randomly

assigned 4-week reporting period. A visit was defined as a

direct, personal exchange between a patient and a physician,

or a staff member acting under a physician’s direction, for the

purpose of seeking care and rendering health services. Visits

solely for administrative purposes, such as payment of a bill,

and visits in which no medical care was provided, such as

visits to deliver a specimen, were out of scope.

The target numbers of Patient Record forms to be completed for ED’s and OPD’s were 50 and 150, respectively. In

clinics with volumes higher than these desired figures, visits

were sampled by a systematic procedure that selected every

nth visit after a random start. Visit sampling rates were

determined from the expected number of patients to be seen

during the reporting period and the desired number of completed Patient Record forms. In the 1992 NHAMCS, Patient

Record forms were completed for 36,271 ED visits and 35,114

OPD visits.

Data collection and processing

Field procedures

The Bureau of the Census, Housing Surveys Branch,

served as the data collection agent for the 1992 NHAMCS.

Data collection forms and other survey instruments are shown

in appendix III.

Approximately 3 months prior to the hospital’s assigned

reporting period, an introductory letter personally signed by

the Director of NCHS was mailed to the hospital administrator

or chief executive of each sampled hospital. In addition to the

introductory letter, NCHS also enclosed endorsing letters from

the American Hospital Association, the Emergency Nurses

Association, and the American College of Emergency Physicians to emphasize the importance of the study to the medical

community.

About 1 week after the mailing of the introductory letter,

the Census field representative called the hospital administrator to arrange for an appointment to further explain the study

and to verify hospital eligibility for the survey. During the

Table II. Distribution of hospitals in the National Hospital Ambulatory Medical Care Survey by reporting period and response status:

United States, 1992

Response status

Reporting period1

Total 01 02 03 04 05 06 07 08 09 10 11 12 13 14

Total . . . . . . . . . . . . . . . . . . . . 524 38 38 38 38 37 38 37 38 37 37 37 37 37 37

A. Complete . . . . . . . . . . . . . . . 437 32 27 35 34 31 35 32 33 32 30 29 29 28 30

B. Out of scope . . . . . . . . . . . . . 50 34124143346465

Federal hospital ........... 0 00000000000000

No ED or OPD2 . . . . . . . . . . . 34 23123002333354

Other . . . . . . . . . . . . . . . . . . 16 11001141013111

C. Refused . . . . . . . . . . . . . . . . 37 37222212232432

D. Response rate in percent3 ..... 92.2 91.4 79.4 94.6 94.4 93.9 94.6 97.0 94.3 94.1 90.9 93.5 87.9 90.3 93.8

1Reporting periods were as follows:

01 = Dec. 2, 1991 - Dec. 29, 1991 08 = June 15, 1992 - July 12, 1992

02 = Dec. 30, 1991 - Jan. 26, 1992 09 = July 13, 1992 - Aug. 9, 1992

03 = Jan. 27, 1992 - Feb. 23, 1992 10 = Aug. 10, 1992 - Sep. 6, 1992

04 = Feb. 24, 1992 - Mar. 22, 1992 11 = Sep. 7, 1992 - Oct. 4, 1992

05 = Mar. 23, 1992 - Apr. 19, 1992 12 = Oct. 5, 1992 - Nov. 1, 1992

06 = Apr. 20, 1992 - May 17, 1992 13 = Nov 2, 1992 - Nov. 29, 1992

07 = May 18, 1992 - June 14, 1992 14 = Nov. 30, 1992 - Dec. 27, 1992

2ED is emergency department; OPD is outpatient department.

3Response rate is A (completions) divided by sum of A+C (completions plus refusals).

73
initial meeting with the administrator, the field representative

explained the purpose of the survey, described the data

collection methods and length of data collection, and obtained

general descriptive information about the organization of the

emergency and outpatient departments and specific information needed to sample clinics within the hospitals.

Hospital information collected during this interview was

recorded by the field representative on NHAMCS-101. The

purpose of this questionnaire was to screen sample hospitals,

verify the hospital sampling frame information, induct the

sample hospitals, and obtain emergency and outpatient department data. The field representative also completed an Ambulatory Unit Record (NHAMCS-101/U) for each clinic and

emergency service area in the hospital, regardless of whether it

was selected to participate, to collect information on the location,

directory, types of services provided, hours of operation, etc. If an

ambulatory unit was eligible for the study but was not selected to

participate, only the first section was completed. If the unit was

selected, all sections were completed.

After the initial visit and the development of the sampling

plan, the field representative contacted the hospital coordinator

to arrange for the induction of the sample emergency service

areas and outpatient clinics and for instruction of the hospital

staff. At these visits, the purpose and use of the survey data

were described and the data collection process was explained.

In cases where clinics kept suitable appointment logs,

these were used as the sampling frame for visits. In cases

where a log was not available, the field representative supplied

the clinic with a Patient Visit Log (NHAMCS-103) to record

patient names. To ensure patient confidentiality, logs were

retained by the hospital at the end of the study period. The

field representative used the NHAMCS-124 Sampling and

Information Booklet to determine the random starts and ‘‘take

every’’ numbers for sampled clinics and emergency service

areas.

Data collection

Visit sampling and data collection for the NHAMCS was

primarily the responsibility of hospital staff. Patient visit data

were recorded for each sample visit using either a prospective

or retrospective data collection method. In the prospective

approach, hospital staff sampled patient visits and then completed Patient Record forms (largely through observation)

during or shortly after the sample visits. In the retrospective

approach, hospital staff sampled visits after patients were seen

and completed Patient Record forms through medical records

abstraction. Hospital staff responsible for completing these

forms were given item-by-item instruction by Census field

representatives. Separate instruction booklets for emergency

service areas and outpatient department clinics were prepared

and given to hospital staff to assist them in this task.

A brief, one-page Patient Record form consisting of two

sections was completed for each sample visit. To account for

the differences in emergency and outpatient care, different

Patient Record forms were developed for each of these

settings. The top section of both forms, containing the patient’s

name and patient record number, was separated from the

bottom section by a perforation running across the page. The

top section remained attached to the bottom until the entire

form was completed. To ensure confidentiality, the top section

was later detached and retained by hospital staff who were

instructed to keep it for a 4-week period in case it became

necessary for Census staff to clarify recorded information or to

retrieve missing data during the data review process.

The bottom section of the Patient Record form consisted

of 18 items for outpatient department clinics or 19 items for

emergency service areas. These items focused on patient

demographics and specific information about the visit. The

Patient Record forms were modeled after those used in the

National Ambulatory Medical Care Survey. Time for completion was estimated at 2 to 3 minutes per form.

Field quality control

The field representative visited the sampled emergency

service areas and clinics each week during the 4-week reporting period and maintained telephone contact with hospital staff

involved in the data collection effort. Census staff monitored

the completeness of the patient sampling frame and adherence

to the sampling procedures. They reviewed the appointment

log or other records used for visit sampling to determine if any

cases were missing, and also edited completed survey forms

for missing data. Attempts were made to retrieve missing

cases and missing data on specific cases either by consulting

with hospital staff or by reviewing the pertinent medical

records.

On the final visit, the field representative collected the

remaining Patient Record forms and obtained or verified the

total count of visits occurring during the reporting period by

reviewing the log used for sample selection or by obtaining

counts directly from hospital staff. Because this information

was critical to the estimation process, extensive effort was

made to ensure the accuracy of this number.

Data processing

Data from the 1992 NHAMCS were coded by trained

medical coding personnel from the Division of Data Processing, Health Surveys Section, at the NCHS computer facility in

Research Triangle Park, North Carolina. Information on the

‘‘patient’s complaint(s), symptom(s), or other reason(s) for

this visit’’ (item 10, OPD Patient Record form and item 11, ED

Patient Record form) were coded according to A Reason for

Visit Classification for Ambulatory Care (10). The physician’s

diagnoses (item 11, OPD Patient Record form and item 12, ED

Patient Record form) were coded according to the International Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM) (11). Item 10 of the ED Patient Record

form (‘‘Cause of Injury’’) was coded according to the ICD–

9–CM Supplemental Classification of External Causes of

Injury and Poisoning (E-codes). A maximum of three entries

was coded from each of these items.

Drug data collected in item 16 (OPD) and item 17 (ED) of

the Patient Record forms were coded and classified according

to a scheme developed at NCHS based on the American

Society of Hospital Pharmacists’ Drug Product Information

74
File, which is maintained by the American Druggist Blue

Book Data Center. A maximum of five entries was coded from

the drug item. A description of the drug coding scheme used in

coding NAMCS and NHAMCS data has been published (27).

In addition to followups by field staff for missing and

inconsistent data, numerous clerical edits were performed on

data received for central data processing. Detailed editing

instructions were provided to manually review the Patient

Record forms and to reclassify or recode entries of ‘‘other’’

where possible. Computer edits for code ranges and inconsistencies were also performed.

All medical and drug coding and keying for the NHAMCS,

as well as straight-key items, involved a two-way 10-percent

independent verification procedure. As an additional quality

check, all Patient Record forms with differences between

coders or with illegible entries for the reason for visit,

diagnosis, cause of injury, or medication items were reviewed

and adjudicated at NCHS. The average keying error rate for

nonmedical items was 0.5 percent. For items that required medical coding, discrepancy rates averaged less than 5 percent.

Item nonresponse was low, 3 percent or less for all data

items except the following: race (8 percent), ethnicity (15 percent), whether the patient had been seen before for the same

condition (item 12 on the OPD form) (7 percent), and whether

the visit was alcohol or drug related (item 14 on the ED form)

(8 percent).

In the case of missing or incomplete data, imputations

were performed for the items listed below, using a ‘‘hot deck’’

procedure by assigning a value from a randomly selected

Patient Record form with similar characteristics. For item 13

on the ED form (urgency), the sorting used was ED size by the

three-digit ICD–9–CM code for principal diagnosis. For other

ED variables (item 4, date of birth; item 5, sex; item 6, race;

item 7, ethnicity; item 14, alcohol- or drug-related visit; item

18, disposition; and item 19, providers seen) the sort used was

ED size by urgency by the three-digit ICD–9–CM code for

principal diagnosis. ED size was determined from the entry on

the NHAMCS-101/U form.

For the OPD data, imputation procedures were performed

for the following variables: item 4, date of birth; item 5, sex;

item 6, race; item 7, ethnicity; item 9, referral; item 12, patient

seen before; item 17, disposition; and item 18, providers seen.

The sort used was OPD size by clinic type by three-digit

ICD–9–CM code for principal diagnosis. OPD size was determined from the entry on the NHAMCS-101/U form, and clinic

type used the following categories: general medicine, surgery,

pediatrics, obstetrics and gynecology, substance abuse, and

other. Records with imputed variables were flagged as such on

the public-use data tape.

Estimation procedures

The probability sample design of the NHAMCS allowed

the sample data to be weighted to produce national estimates

for the United States. Unweighted data are not used for

analysis as unweighted data ignore the disproportionate sampling used in the NHAMCS.

Statistics from the NHAMCS were derived by a multistage estimation procedure that produces essentially unbiased

national estimates. Separate national estimates were produced

for visits to hospital emergency departments and outpatient

departments. The weight included three basic components:

inflation by reciprocals of the probabilities of selection, adjustment for nonresponse, and ratio adjustment to fixed totals.

Inflation by reciprocals of probabilities of selection

Because the survey utilized a four-stage sample design,

four probabilities of selection existed: the probability of

selecting the PSU; the probability of selecting the hospital

within the PSU; the probability of selecting the emergency

service area or outpatient clinic within the hospital; and the

probability of selecting the visit within the particular emergency service area or clinic. The overall probability of including a hospital in the sample was the product of the probability

of the PSU being selected multiplied by the probability of the

hospital being selected. The probability of selecting the hospital was 1.0 for hospitals in noncertainty PSU’s with fewer than

five hospitals and was the hospital size divided by a sampling

interval for all other hospitals. The sampling intervals for

PSU’s with more than five hospitals was the cumulative sum

of the hospital sizes (the total of ED and OPD visits) in each

PSU divided by five. The sampling interval for certainty

PSU’s was the cumulative sum of all of the hospitals in these

PSU’s divided by 240.

The probability of selecting a clinic within a hospital was

1.0 for clinics in hospitals with five or fewer clinics and was

the clinic size divided by the sampling interval for hospitals

with more than five clinics. The sampling interval was defined

as the cumulative sum of sizes for the clinics (the expected

number of visits during the reporting period) in the hospital

divided by five.

The probability of selecting a visit was defined as the

actual number of visits during the hospital’s assigned reporting period divided by the number of Patient Record forms

completed. Estimates were adjusted to account for the extended

data collection period for the 1992 survey, which included 14

4-week reporting periods from December 2, 1991, through

December 27, 1992. Subsequent survey years will include 13

4-week reporting periods that will be inflated to derive annual

estimates.

Adjustments for nonresponse

Estimates from NHAMCS data were adjusted to account

for sample units that were in scope but did not participate in

the study. The adjustments were calculated to minimize the

impact of nonresponse on final estimates by imputing to

nonresponding units the characteristics of similar responding

units. As nonresponse may occur at each stage of sampling,

several adjustments were required. For these adjustments,

hospitals were judged similar if they had the same ownership

and were in the same PSU or region and MSA status. Clinics

were judged similar if they were of the same clinic type and

were in the same PSU. Visits were judged similar if they

occurred in the same clinic.

75
Ratio adjustment

NHAMCS estimates were adjusted within 12 strata defined

by region and ownership. Separate poststratification adjustments were made for emergency and outpatient estimates. For

ED estimates, the ratio adjustment for each stratum was a

multiplication factor whose numerator was the number of ED

visits in the universe in the stratum and whose denominator

was the estimated number of ED visits in that stratum. For

OPD estimates, the ratio adjustment for each stratum was a

multiplication factor whose numerator was the number of

hospitals with an OPD in the universe in the stratum and

whose denominator was the estimated number of hospitals

with OPD’s in that stratum. The data for the numerator and

denominator of both adjustments were based on figures from

the SMG Hospital Market Database.

Reliability of estimates

Because statistics from the NHAMCS are based on a

sample, they may differ somewhat from the figures that would

be obtained if a complete census were taken using the same

forms, definitions, instructions, and procedures. However, the

probability design of the NHAMCS permitted the calculation

of sampling errors. The standard error is primarily a measure

of sampling variability that occurs by chance because only a

sample rather than the entire population is surveyed. The

standard error, as calculated for the NHAMCS, also reflects

part of the variation that arises in the measurement process,

but does not include estimates of any systematic biases that

may be in the data. The relative standard error (RSE) of an

estimate is obtained by dividing the standard error by the

estimate itself and is expressed as a percent of the estimate.

Generally, an asterisk (*) is used to indicate any estimate with

a relative standard error greater than 30 percent. Estimates

based on fewer than 30 sample records are not presented in

this report. In these cases, only an asterisk (*) appears.

In repeated samples using the same forms and procedures,

the chances are about 68 of 100 that an estimate from the

sample would differ from a complete census by less than the

standard error. The chances are about 95 of 100 that the

difference would be less than twice the standard error and

about 99 of 100 that it would be less than 2 1/2 times as large.

Estimation of standard errors

Estimates of sampling variability were calculated with

SUDAAN software, which computes standard errors using a

first-order Taylor approximation of the deviation of estimates

from their expected values. A description of the software and

the approach it uses has been published (28).

Standard error approximations

The SUDAAN procedure can be used to compute directly

the standard errors and relative standard errors for NHAMCS

estimates. However, this is not practical or feasible for all

users of the data. Therefore, a generalized procedure for

approximating the relative standard errors for NHAMCS

estimates was developed.

Relative standard errors were computed for estimates in

the Advance Data reports on emergency and outpatient departments (1,2). Regression techniques were then used to produce

equations from which a standard error for any estimate may be

approximated. The regression equations, represented by the

parameters a and b, are shown in table III. Separate equations

were produced for estimates of visits and drug mentions.

Rules explaining the use of these equations are presented in

the following section.

To derive error estimates that would be applicable to a

wide variety of statistics and could be prepared at moderate

cost, several approximations were required. As a result, standard errors computed using this procedure should be interpreted as approximate rather than exact for any specific

estimate. The coefficients of determination (r

2

) for the ED and

OPD visit equations are 0.62 and 0.43, respectively, and are

0.82 and 0.57, respectively, for the ED and OPD drug mention

equations. Particular attention should be exercised when the

estimate of interest is small or when this procedure is used for

estimates based on the American Indian/Eskimo/Aleut or

Asian/Pacific Islander race categories. Further, because of the

small number of cases in each category, these error estimates

do not apply to estimates of ambulatory surgical procedures in

the outpatient department data.

Estimates of standard errors for aggregate

estimates

Approximate relative standard errors for estimates of the

number of visits (or drug mentions) with a particular characteristic may be computed using the following formula, where x

is the aggregate estimate of interest and a and b are the

appropriate coefficients from table III:

RSE(x) = Œ a +

b

x

Approximate relative standard errors for aggregated estimates are shown in tables IV and V. Table IV presents approximate relative standard errors for aggregate estimates of hospital

emergency department visits, and table V presents approximate relative standard errors for aggregate estimates of drug

mentions at visits to hospital emergency departments.

Table III. Coefficients appropriate for determining approximate

relative standard errors by type of estimate and service area:

National Hospital Ambulatory Medical Care Survey, 1992

Type of estimate and

service area

Coefficient appropriate for use

with estimates in thousands

Visits A B

Emergency department ...... 0.00158 5.0405

Outpatient department ....... 0.00912 7.5165

Drug mentions

Emergency department ...... 0.00235 5.1429

Outpatient department ....... 0.01395 5.5191

76
Estimates of rates where the denominator is

assumed to have negligible error

The approximate relative standard error for a rate in

which the denominator is the total U.S. population or one or

more of the age-sex-race groups of the total population is

equivalent to the relative standard error of the numerator. This

is obtained using the relative standard error formula above

with the appropriate coefficients from table III. The standard

error is then given by:

SE (r) = r c RSE (r)

Estimates of standard errors of percents where the

numerator and the denominator are estimated from

the same sample

Approximate relative standard errors (in percent) for

estimates of percents may be computed using the appropriate

relative standard errors for the aggregate statistics as follows.

Obtain the approximate relative standard error of the numerator and denominator of the percent. Square each of the relative

standard errors, subtract the resulting value for the denominator from the resulting value for the numerator, extract the

square root, and multiply by 100.

RSE ( p) = RSE (x/y) = √ RSE2 (x) – RSE2 ( y) c 100

Alternatively, approximate relative standard errors (in

percent) for estimates of percents of visits (or drug mentions)

may be computed using the following formula, where p is the

percent of interest, x is the denominator of the percent, and b

is the appropriate coefficient from table III:

RSE ( p) = Œ b c 1 – p

p c x c 100

The approximation of the absolute or relative standard

error is valid if the relative standard error of the denominator

is less than 0.05 (29) or if the relative standard errors of the

numerator and denominator are both less than 0.10 (30).

Approximate relative standard errors (in percent) for

estimates of percents are shown in tables VI (visits) and VII

(drug mentions).

Estimates of rates (r=x/y) where numerator is not a

subclass of the denominator

The standard error for a rate may be approximated by:

RSE (r) = RSE (x/y) = √ RSE2 (x) + RSE2 ( y) c 100

SE (r) = r c RSE (r)

This approximation is valid if the relative standard error

of the denominator is less than 0.05 (29) or if the relative

standard errors of the numerator and denominator are both less

than 0.10 (30).

Estimates of the differences between two

statistics

The standard error of the difference between two statistics

is approximated by the following formula, where SE(x1) and

SE(x2) are computed using the formulas given above:

SE (x1 – x2) = √ SE2(x1) + SE2 (x2)

This formulation represents the standard error for the

difference between separate and uncorrelated characteristics,

although it is only a rough approximation in most other cases.

Table IV. Approximate relative standard errors for estimated

numbers of emergency department visits: National Hospital

Ambulatory Medical Care Survey, 1992

Estimated number

of visits in thousands

Relative standard

error in percent

10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71.1

20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50.4

50 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32.0

58 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29.7

100 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.8

200 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.4

500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.8

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.1

2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.4

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.6

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.3

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.1

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.0

NOTE: The smallest reliable estimate for visits to hospital emergency departments is 58,000.

Estimates below this figure have a relative standard error greater than 30 percent and are

deemed unreliable by NCHS standards.

Example of use of table: An aggregrate estimate of 20 million visits has a relative standard

error of 4.3 percent or a standard error of 860,000 visits (4.3 percent of 20 million).

Table V. Approximate relative standard errors for estimated

numbers of drug mentions at emergency department visits:

National Hospital Ambulatory Medical Care Survey, 1992

Estimated number

of drug mentions in thousands

Relative standard

error in percent

10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71.9

20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50.9

50 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32.4

59 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29.9

100 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23.1

200 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.6

500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.1

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.5

2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.8

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.5

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.0

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.8

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.6

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.5

200,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.5

NOTE: The smallest reliable estimate of drug mentions at visits to hospital emergency

departments is 59 million. Estimates below this figure have a relative standard error greater

than 30 percent and are deemed unreliable by NCHS standards.

Example of use of table: An aggregrate estimate of 10 million drug mentions has a relative

standard error of 5.5 percent or a standard error of 550,000 drug mentions (5.5 percent of 10

million).

77
Tests of significance

In this report, the determination of statistical inference

is based on the two-tailed t-test. The Bonferroni inequality

was used to establish the critical value for statistically

significant differences (0.05 level of significance) based on

the number of possible comparisons within a particular

variable (or combination of variables) of interest. Terms

relating to differences such as ‘‘greater than’’ and ‘‘less

than’’ indicate that the differences are statistically significant. Terms such as ‘‘similar’’ or ‘‘no difference’’ mean that

no statistical significance exists between the estimates

being compared. A lack of comment regarding the differences between any two estimates does not mean that the

difference was tested and found to be not significant.

Population figures

The population figures used in computing annual rates are

shown in tables VIII–X. They are based on July 1, 1992,

estimates of the civilian noninstitutionalized population of the

United States. This population has been used in previously

published NHAMCS data (1–4). The reader should note,

however, that it may, in some cases, be desirable to use the

civilian resident population of the United States in the calculation of visit rates, especially when analyzing data pertaining

to ED utilization by older persons.

The civilian resident population includes civilians residing in institutional settings, such as nursing homes and

prisons. At present, no data are available that would

estimate the extent of ED utilization by these population

Table VI. Approximate standard errors of percents of estimated numbers of emergency department visits: National Hospital Ambulatory

Medical Care Survey, 1992

Base of percent

(visits in thousands)

Estimated percent

1 or 99 5 or 95 10 or 90 20 or 80 30 or 70 40 or 60 50

Standard error in percentage points

10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.1 15.5 21.3 28.4 32.5 34.8 35.5

20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.0 10.9 15.1 20.1 23.0 24.6 25.1

50 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.2 6.9 9.5 12.7 14.6 15.6 15.9

100 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.2 4.9 6.7 9.0 10.3 11.0 11.2

200 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.6 3.5 4.8 6.4 7.3 7.8 7.9

500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.0 2.2 3.0 4.0 4.6 5.9 5.0

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.7 1.5 2.1 2.8 3.3 3.5 3.6

2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.5 1.1 1.5 2.0 2.3 2.5 2.5

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.3 0.7 1.0 1.3 1.5 1.6 1.6

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2 0.5 0.7 0.9 1.0 1.1 1.1

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2 0.3 0.5 0.6 0.7 0.8 0.8

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.1 0.2 0.3 0.4 0.5 0.5 0.5

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.1 0.2 0.2 0.3 0.3 0.3 0.4

Example of use of table: An estimate of 40 percent based on an aggregate estimate of 10 million visits has a standard error of 1.1 percent or a relative standard error of 2.8 percent (1.1 percent

divided by 40 percent).

Table VII. Approximate standard errors of percents of estimated numbers of drug mentions at emergency department visits:

National Hospital Ambulatory Medical Care Survey, 1992

Base of percent

(drug mentions in thousands)

Estimated percent

1 or 99 5 or 95 10 or 90 20 or 80 30 or 70 40 or 60 50

Standard error in percentage points

10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.1 15.6 21.5 28.7 32.9 35.1 35.9

20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.0 11.1 15.2 20.3 23.2 24.8 25.4

50 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.2 7.0 9.6 12.8 14.7 15.7 16.0

100 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.3 4.9 6.8 9.1 10.4 11.1 11.3

200 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.6 3.5 4.8 6.4 7.4 7.9 8.0

500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.0 2.2 3.0 4.1 4.6 5.0 5.1

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.7 1.6 2.2 2.9 3.3 3.5 3.6

2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.5 1.1 1.5 2.0 2.3 2.5 2.5

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.3 0.7 1.0 1.3 1.5 1.6 1.6

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2 0.5 0.7 0.9 1.0 1.1 1.1

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2 0.3 0.5 0.6 0.7 0.8 0.8

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.1 0.2 0.3 0.4 0.5 0.5 0.5

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.1 0.2 0.2 0.3 0.3 0.3 0.4

200,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.1 0.1 0.2 0.2 0.2 0.2 0.3

Example of use of table: An estimate of 50 percent based on an aggregate estimate of 10 million visits has a standard error of 1.1 percent or a relative standard error of 2.2 percent (1.1 percent

divided by 50 percent).

78
subgroups, but it is certain that nursing home residents and

other institutional residents utilize the ED to some degree.

A comparison of visit rates by age, sex, and race using both

populations yields no significant differences for nonelderly

visit rates. Use of the civilian resident population does,

however, result in a decrease in the ED visit rate for

females ages 75 years and over. Additional information on

population estimates can be obtained by contacting the

Ambulatory Care Statistics Branch.

Table VIII. Estimates of the civilian noninstitutionalized population by selected demographic characteristics: United States, 1992

Characteristic All ages

Under

15 years

15–24

years

25–44

years

45–64

years

65–74

years

75 years

and over

Race and sex

All races ............. 251,448,459 56,442,611 34,384,602 81,328,380 48,501,115 18,469,880 12,321,871

Male .............. 122,187,479 28,891,742 17,097,767 39,999,651 23,305,965 8,275,207 4,617,147

Female ............ 129,260,980 27,550,869 17,286,835 41,328,729 25,195,150 10,194,673 7,704,724

White .............. 209,464,504 44,985,523 27,479,788 67,716,634 41,743,184 16,385,982 11,153,393

Male .............. 102,413,873 23,046,144 13,776,312 33,733,182 20,299,022 7,375,023 4,184,190

Female ............ 107,050,631 21,939,379 13,703,476 33,983,452 21,444,162 9,010,959 6,969,203

Black ............... 31,461,180 8,954,786 5,100,047 9,795,332 4,989,293 1,643,778 977,944

Male .............. 14,722,087 4,555,607 2,450,005 4,424,866 2,227,631 711,472 352,506

Female ............ 16,739,093 4,399,179 2,650,042 5,370,466 2,761,662 932,306 625,438

Other ............... 10,522,775 2,502,302 1,804,767 3,816,414 1,768,638 440,120 190,534

Male .............. 5,051,519 1,289,991 871,450 1,841,603 779,312 188,712 80,451

Female ............ 5,471,256 1,212,311 933,317 1,974,811 989,326 251,408 110,083

Table IX. Estimates of the civilian noninstitutionalized population by selected demographic characteristics and geographic region:

United States, 1992

Characteristic

All

regions Northeast Midwest South West

Total ..................................... 251,448,459 50,000,327 61,472,387 84,419,002 55,556,743

Age

Under 15 years .............................. 56,442,611 10,427,006 13,672,495 19,012,938 13,330,172

15–24 years ................................ 34,384,602 6,362,047 8,801,900 11,624,054 7,596,601

25–44 years ................................ 81,328,380 16,202,952 19,756,983 26,906,444 18,462,001

45–64 years ................................ 48,501,115 10,186,743 11,751,313 16,262,621 10,300,438

65–74 years ................................ 18,469,880 4,054,432 4,373,242 6,410,161 3,632,045

75 years and over ............................. 12,321,871 2,767,147 3,116,454 4,202,784 2,235,486

Sex

Male ..................................... 122,187,479 24,103,345 29,796,974 40,896,688 27,390,472

Female ................................... 129,260,980 25,896,982 31,675,413 43,522,314 28,166,271

Race

White .................................... 209,464,504 42,942,018 53,919,793 65,756,469 46,846,224

Black ..................................... 31,461,180 5,396,473 6,419,569 17,017,761 2,627,377

Other ..................................... 10,522,775 1,661,836 1,133,025 1,644,772 6,083,142

Table X. Estimates of the civilian noninstitutionalized population

by race and urbanicity: United States, 1992

Race All areas MSA1 Non-MSA1

All races ........... 251,448,459 196,606,190 54,842,269

White ........... 209,464,504 160,943,298 48,521,206

Black ........... 31,461,180 26,675,109 4,786,071

Other ........... 10,522,775 8,987,783 1,534,992

1MSA is metropolitan statistical area.

79
Rounding of numbers

Estimates presented in this report are rounded to the

nearest thousand. For this reason, detailed figures within tables

do not always add to totals. Rates and percents are calculated

on the basis of the original, unrounded figures and may not

agree precisely with rates and percents calculated from rounded

data.

Nonsampling error

Estimates based on the 1992 NHAMCS are subject to

nonsampling as well as sampling errors. Nonsampling errors

include reporting and processing errors, as well as biases due

to nonresponse or incomplete response. Although the magnitude of the nonsampling errors cannot be computed, these

errors are kept to a minimum by procedures built into the

operation of the survey. To eliminate ambiguities and encourage uniform reporting, careful attention was given to the

phrasing of questions, terms, and definitions. Also, extensive

pretesting of most data items and survey procedures was also

performed. The steps taken to reduce bias in the data are

discussed in the sections on field procedures and data collection. Quality control procedures, consistency, and edit checks

discussed in the data processing section reduced errors in data

coding and processing. Because survey results are subject to

sampling and nonsampling errors, the total error will be larger

than the error due to sampling variability alone.

80
Appendix II

Definitions of terms

Terms relating to the survey

Patient—An individual seeking personal health services

not currently admitted to any health care institution on the

premises. A person under a physician’s care for health reasons.

Patients are defined as in scope or out of scope as follows:

+ In scope—A patient seen by hospital staff in an in-scope

emergency service area or clinic except as excluded below.

+ Out of scope—Patients seen by physicians in private

offices, nursing homes, or other extended care institutions

or in the patient’s home. Patients who contact and receive

advice from hospital staff via telephone. Patients who

come to the hospital only to leave a specimen, to pick up

insurance forms, to pick up medication, or to pay a bill.

Visit—A visit is a direct, personal exchange between an

ambulatory patient and a physician or other health care

provider working under the physician’s supervision, for the

purpose of seeking care and receiving personal health services.

Drug mention—The entry of a pharmaceutical agent

ordered or provided by any route of administration for prevention, diagnosis, or treatment. Generic as well as brand name

drugs are included, as are nonprescription as well as prescription drugs. Along with all new drugs, the hospital staff also

records continued medication if the patient was specifically

instructed during the visit to continue the medication.

Hospital—All hospitals with an average length of stay for

all patients of less than 30 days (short stay) or hospital whose

specialty is general (medical or surgical) or children’s general

are eligible for the National Hospital Ambulatory Medical

Care Survey, except Federal hospitals and hospital units of

institutions and hospitals with less than six beds staffed for

patient use.

Ownership—Hospitals are designated according to the

primary owner of the hospital based on the SMG Hospital

Market Database.

+ Voluntary nonprofit—Hospitals operated by a church or

another nonprofit organization.

+ Government, non-Federal—Hospitals operated by State or

local governments.

+ Proprietary—Hospitals operated by individuals, partnerships, or corporations for profit.

Urbanicity—Hospitals are classified by their location in a

metropolitan or nonmetropolitan area.

+ Metropolitan—Metropolitan Statistical Area (MSA) as

defined by the U.S. Office of Management and Budget.

The definition of an individual MSA involves two

considerations: first, a city or cities of specified population

that constitute the central city and identify the county in

which it is located as the central county; second, economic

and social relationships with ‘‘contiguous’’ counties that

are metropolitan in character so that the periphery of the

specific metropolitan area may be determined. MSA’s may

cross State lines. In New England, MSA’s consist of cities

and towns rather than counties.

+ Nonmetropolitan—Other than metropolitan.

Emergency department—Hospital facility for the provision

of unscheduled outpatient services to patients whose conditions

require immediate care and staffed 24 hours a day. Emergency

departments that are open less than 24 hours a day are included as

part of the hospital’s outpatient department.

Emergency service area—Area within the emergency

department where emergency services are provided. This

includes services provided under the ‘‘hospital as landlord’’

arrangement in which the hospital rents space to a physician

group.

Outpatient department—Hospital facility where nonurgent ambulatory medical care is provided under the supervision of a physician.

Clinic—Administrative unit within an organized outpatient department that provides ambulatory medical care under

the supervision of a physician. This excludes the ‘‘hospital as

landlord’’ arrangement in which the hospital only rents space

to a physician group and is not otherwise involved in the

delivery of services. Clinics are grouped into the following six

specialty groups for purposes of systematic sampling and

nonresponse adjustment: general medicine, surgery, pediatrics,

obstetrics/gynecology, substance abuse, and other. Clinics are

defined as in scope or out of scope as follows:

+ In scope—General medicine

AIDS

Allergy

Ambulatory care

Anti-coagulation

Anesthesia/pain

Apnea

Arthritis

Asthma

Brain tumor (and other tumor)

81
Cardiology

Cerebral palsy (adult)

Chest

Coagulant

Cystic fibrosis (adult)

Cytomegalovirus

Dermatology

Diabetes

Diabetic counseling

Digestive diseases

Down’s syndrome (adult)

Endocrinology

Epilepsy

Family practice

Gastroenterology

General medicine

Genetics (adult)

Geriatric

Head (nonsurgical)

Head and neck (nonsurgical)

Hematology

Hemophilia (adult)

Homeless

Huntington’s disease/chorea

Hyperlipidemia

Hypertension

Immunology

Infectious diseases

Internal medicine

Lead poisoning (adult)

Leukemia/bone marrow aspiration

Lipid

Liver

Lupus (systemic lupus erythematosus)

Medical screening

Melanoma

Metabolic

Movement and memory disorders

Multiple sclerosis

Muscular dystrophy

Myelomeningocele

Nephrology

Neurocutaneous

Oncology

Outreach program (general medicine)

Pacemaker

Pentamidine

Peripheral vascular disease

Pheresis/plasma pheresis

Pigmented lesion

Primary care

Pulmonary

Renal

Rheumatology

Seizure

Senior care

Sexually transmitted diseases (STD)

Sickle cell (adult)

Spina bifida (adult)

Thyroid

Tuberculosis

Urgent care

Walk-in and/or screening

Weight management

24-hour observation

+ In scope—Surgery

Amputee (surgery and rehabilitation)

Ano-rectal

Arthroscopy

Back care

Breast

Breast care

Bronchoscopy

Burn

Cardiothoracic

Cast/brace

Chief resident followup (surgery)

Chronic wound

Cleft palate

Club foot

Colon and rectal surgery

Cryosurgery

Cystoscopy

Elective surgery

Endoscopy

ENT (ear, nose, and throat)

Eye

Fine needle aspiration

Fracture

General surgery

Genitourinary

Genitourinary surgery

Hand surgery

Head and neck surgery

Knee

Lithotripsy

Myelo- (and other myelo)

Neurologic surgery

Oncologic surgery

Ophthalmologic surgery

Ophthalmology

Orthopedic

Orthopedic surgery

Ostomy

Otolaryngology

Otolaryngologic surgery

Otology

Otorhinolaryngology

Pediatric ear, nose, and throat

Pediatric orthopedic surgery

Pediatric otolaryngology

Pediatric surgery

Pediatric urology

Plastic surgery

Post-operative

82
Proctology

Pulmonary/thoracic surgery

Scoliosis (adult)

Sigmoidoscopy

Spine

Sports medicine

Suture

Transplant surgery

Trauma

Urodynamics

Urologic surgery

Urology

Vascular surgery

Visual fields

+ In scope—Pediatrics

Adolescent/young adult

Adolescent medicine

Airway (pediatric)

Allergy (pediatric)

Behavior and development (child)

Birth defect

Cardiology (pediatric)

Cerebral palsy (child)

Child sexual assault

Clotting (pediatric)

Congenital heart

Continuity (pediatric)

Craniofacial

Craniomalformation

Critical care (pediatric)

Cystic fibrosis

Dermatology (pediatric)

Developmental disability

Developmental evaluation

Diagnostic (pediatric)

Down’s syndrome (child)

Endocrinology (pediatric)

Gastroenterology (pediatric)

Genetics

Hematology (pediatric)

Hemoglobinopathy (pediatric)

Hemophilia (child)

High risk (pediatric)

Infant apnea

Infectious diseases (pediatric)

Lead poisoning (child)

Learning disorder

Neonatology

Nephrology (pediatric)

Newborn

Oncology (pediatric)

Ophthalmology (pediatric)

Pediatrics

Perinatal

Phenylketonuria

Pulmonary (pediatric)

Regional development

Rheumatic heart

Rheumatology/arthritis (pediatric)

Scoliosis (child)

Seizure (pediatric)

Sickle cell (child)

Spina bifida

Teenage

Teen-tot

Well child care

+ In scope—Obstetrics/gynecology

Adolescent gynecology

Birth control

Colposcopy

Dysplasia

Family planning

Gynecology

Gynecologic oncology

In vitro fertilization

Infertility

Maternity

Maternal health

Obstetrics

Obstetrics—high risk

Obstetrics—post-partum

Obstetrics—prenatal

Pregnancy—counseling

Pregnancy verification

Prenatal

Preteen gynecology

Reproductive

Reproductive endocrinology

Well woman

Women’s care

+ In scope—Substance abuse

Alcohol abuse

Alcohol detoxification

Alcohol walk-in

Chemical dependency (excluding methadone

maintenance)

Drug abuse (excluding methadone maintenance)

Drug detoxification

Substance abuse

Women’s alcohol program

+ In scope—Other

Adolescent psychiatry

Adult psychiatry

Anxiety

Biofeedback

Child psychiatry

Eating disorder

General preventive medicine

Mental health

Mental hygiene

Myasthenia gravis

Neurology

Neurophysiology

83
Pain management

Partial hospitalization program (psychiatric)

Pediatric neurology

Preventive medicine

Psychopharmacology

Sleep disorder

Social evaluation

Toxicology

+ Out of scope—Other

Abortion/pregnancy termination

Ambulatory surgery centers

Blood bank

Cardiac catheterization

Chemotherapy

Dental/dental oncology/dental surgery

Employee health service

Hemodialysis

Kidney (renal) dialysis

Methadone maintenance

Occupational safety and health

Occupational therapy

Oral surgery

Pharmacy

Physical medicine/therapy

Podiatry

Radiation therapy/radiation diagnosis/radiation oncology

Radiology/diagnostic x ray (imaging)

Reading and language

Rehabilitation

Region—Hospitals are classified by location in one of the

four geographic regions of the United States that correspond to

those used by the U.S. Bureau of the Census.

Region States included

Northeast Maine, New Hampshire, Vermont,

Massachusetts, Rhode Island, Connecticut,

New York, New Jersey, and Pennsylvania

Midwest Michigan, Ohio, Illinois, Indiana, Wisconsin,

Minnesota, Iowa, Missouri, North Dakota,

South Dakota, Nebraska, and Kansas

South Delaware, Maryland, District of Columbia,

Virginia, West Virginia, North Carolina, South

Carolina, Georgia, Florida, Kentucky,

Tennessee, Alabama, Mississippi, Arkansas,

Louisiana, Oklahoma, and Texas

West Montana, Idaho, Wyoming, Colorado, New

Mexico, Arizona, Utah, Nevada, Washington,

Oregon, California, Hawaii, and Alaska

Terms relating to the Patient Record forms

Age—The age calculated from date of birth is the age at

last birthday on the date of visit.

Race—Hospital staff were instructed to record based on

observation or the hospital’s usual practice or knowledge. The

following category definitions were provided:

+ White—A person having origins in any of the original

peoples of Europe, North Africa, or the Middle East.

+ Black—A person having origins in any of the black racial

groups of Africa.

+ Asian/Pacific Islander—A person having origins in any of

the original peoples of the Far East, Southeast Asia, the

Indian Subcontinent, or the Pacific Islands. This area

includes, for example, China, India, Japan, Korea, the

Philippine Islands, and Samoa.

+ American Indian/Eskimo/Aleut—A person having origins

in any of the original peoples of North America, and who

maintains cultural identification through tribal affiliation or

community recognition.

Ethnicity—Hospital staff were instructed to mark the

appropriate category based on the hospital’s usual practices.

+ Hispanic origin—A person of Mexican, Puerto Rican,

Cuban, Central or South American, or other Spanish

culture or origin, regardless of race.

+ Not Hispanic—All other persons.

Expected source(s) of payment—Hospital staff were

instructed to check the source(s) that would pay for this visit.

+ Medicare—Charges paid in part or in full by a Medicare

plan. Includes payments made directly to the hospital as

well as payments reimbursed to the patient.

+ Medicaid—Charges paid in part or in full by a Medicaid

plan. Includes payments made directly to the hospital as

well as payments reimbursed to the patient.

+ Other government—Charges paid in part or in full by any

other local, State, or Federal health care programs, such as

workers compensation programs and Civilian Health and

Medical Programs of Uniformed Services (CHAMPUS).

+ Private commercial—Charges paid in part or in full by a

private insurance company. Includes payments made directly

to the hospital as well as payments reimbursed to the

patient.

+ HMO/other prepaid—Charges included under a prepayment plan. Includes health maintenance organizations

(HMO’s), independent practice associations (IPA’s), preferred provider organizations (PPO’s), etc.

+ Patient paid—Charges paid in part or in full by the patient

or the patient’s family that will not be reimbursed by a

third party. Includes ‘‘co-payments’’ and ‘‘insurance deductibles.’’ Excludes prepaid plan visits for which no

co-payment is charged.

+ No charge—Visits for which no fee is charged.

+ Other—Any other source of payment not covered in the

categories above.

Major reason for this visit (ED)—Hospital staff were

instructed to indicate whether this visit is the first visit or

followup visit for an injury or illness.

+ Injury, first visit—Self-explanatory.

84
+ Injury, followup—Self-explanatory.

+ Illness, first visit—Self-explanatory.

+ Illness, followup—Self-explanatory.

+ Other reason—Includes general health maintenance examinations, routine periodic examinations of presumably

healthy persons—both children and adults—and

malingering.

Cause of injury (ED)—Hospital staff were instructed to

describe in detail the events and circumstances surrounding

the injury; for example, the place and cause of injury.

Patient referred (OPD)—Referrals are any visits made at

the advice or direction of the hospital staff other than the ones

being visited. The interest is in referrals for the current visit

and not in referrals for any prior visit.

Patient’s complaint(s), symptom(s), or other reason(s) for

this visit (in patient’s own words)—The patient’s problem,

complaint, symptom, or other reason for this visit as expressed

by the patient. Hospital staff were instructed to record key

words or phrases verbatim to the extent possible. ‘‘Most

important’’ refers to that problem which, in their judgment, is

most responsible for the patient’s visit.

Physician’s diagnosis—The physician’s best assessment

of diagnosis of the patient’s most important problem, complaint, or symptom. The term ‘‘principal’’ refers to the firstlisted diagnosis. The diagnosis represents the hospital staff’s

best judgment at the time of the visit and may be tentative,

provisional, or definitive.

Urgency of this visit (ED)—Hospital staff were instructed

to check the category that best indicates the urgency of the

visit.

+ Urgent/emergent—Patient requires immediate attention for

acute illness or injury that threatens life or function. Delay

would be harmful to the patient.

+ Nonurgent—Patient does not require attention immediately or within a few hours.

Alcohol and/or drug related (ED)—Patient’s most important complaint or presenting problem is alcohol and/or drug

related.

Seen in clinic before (OPD)—‘‘Seen before’’ means provided care in that clinic at any time in the past. The second

part of item 12 refers to the patient’s current condition.

Ambulatory surgery (OPD)—Any surgical procedure performed in the clinic or ordered to be performed elsewhere on

an outpatient basis, including suturing of wounds, reduction of

fractures, application or removal of casts, incision and drainage of abscesses, application of supportive materials for

fractures and sprains, irrigations, aspirations, dilations, and

excisions.

Diagnostic/screening services—Hospital staff were

instructed to mark all services and procedures that were

ordered or provided during this visit for the purpose of

screening or diagnosis.

+ Blood pressure check—Self-explanatory.

+ Urinalysis—Any physical, chemical, or microscopic examination of urine.

+ HIV serology—The study of the human immunodeficiency

virus (HIV) antigen-antibody reaction in vitro.

+ Cholesterol measure—A blood test taken to measure the

level of cholesterol in a patient’s blood.

+ Other blood test (ED)—Self-explanatory.

+ Pap test (OPD)—Papanicolaou test.

+ Strep throat test (OPD)—Rapid strep test or throat culture.

+ Other lab test (OPD)—Self-explanatory.

+ EKG-resting—Resting-electrocardiogram.

+ EKG-exercise (OPD)—Exercise-electrocardiogram.

+ Mental status exam—Any formal, clinical evaluation

designed to assess the mental or emotional status of the

patient.

+ Mammogram (OPD)—x ray of the breasts.

+ Chest x ray—Single or multiple x rays of the chest for

diagnostic or screening purposes. Excludes fluoroscopy

and studies of ribs, bony thorax, and spine.

+ Extremity x ray (ED)—x ray of the arms, legs, hands, or

feet.

+ CT scan/MRI (ED)—Computerized tomography scan/

magnetic resonance imaging.

+ Other diagnostic imaging (ED)—Self-explanatory.

+ Other radiology (OPD)—Self-explanatory.

+ Hearing test (OPD)—Self-explanatory.

+ Visual acuity (OPD)—Self-explanatory.

+ Spirometry (OPD)—Measurement of air capacity of the

lungs.

+ Allergy testing (OPD)—May include the direct introduction of antigen into the skin, allergen inhalation, or

bronchial challenge tests.

Procedures (ED)—Hospital staff were instructed to mark

all procedures provided this visit.

+ Endotracheal intubation—A laryngoscope inserted into

the mouth followed by a tube into the trachea.

+ CPR—Cardiopulmonary resuscitation.

+ IV fluids—Administration of intravenous fluids.

+ NG tube—Insertion of nasogastric tube through the nose,

down the esophagus, and into the stomach.

+ Gastric lavage—Passage of a solution through the inflow

tube into the nose, down the esophagus, and into the

stomach where the gastric contents are irrigated and

returned through an outflow tube.

+ Wound care—Includes cleaning, debridement, and dressing of burns; repair of lacerations with skin tape or

sutures; removal of foreign bodies; excisions; and incision

and drainage.

+ Eye/ENT care—Care provided to the eyes, ears, nose, and

throat; includes measurement of intraocular pressure in the

eyes, removal of ear wax, removal of foreign bodies, nasal

packing, and laryngoscopy.

+ Orthopedic care—Treatment of orthopedic injuries or

conditions; includes casting, wrapping, splinting, and aspiration of fluid from joints.

+ Bladder catheter—Any type of catheter used to catheterize the bladder, for example, Foley.

+ Lumbar puncture—Insertion of a needle into the lumbar

spine to extract spinal fluid for laboratory examination.

+ Other(s) specify—Up to two other diagnostic and/or treatment procedures provided this visit were recorded.

85
Medication—Hospital staff were instructed to list, using

brand or generic names, all medications ordered, injected, administered, or provided this visit including prescription and nonprescription drugs, immunizations, and desensitizing agents. Also

included are drugs and medications ordered or provided prior to

the visit that the patient was instructed to continue taking.

Disposition (ED)—Hospital staff were instructed to mark

all categories that apply.

+ Return to ED PRN—The patient is instructed to return to

the ED as needed.

+ Return to ED-appointment—The patient is told to schedule an appointment or is given an appointment to return to

the ED at a particular time.

+ Return to referring physician—The patient was referred to

the ED by his or her personal physician or some other

physician and is now instructed to consult again with the

physician who made the referral.

+ Refer to other physician/clinic—The patient is instructed

to consult or seek care from another physician or clinic.

The patient may or may not return to this physician or

clinic at a later date.

+ Admit to hospital—The patient is instructed that further

care or treatment will be provided as an inpatient in the

hospital.

+ Transfer to other facility—The patient is transferred to a

facility other than a facility operated under the auspices of

this hospital.

+ DOA/died in the ED—If the patient is dead on arrival

(DOA) or died in the ED, this patient is still included in

the sample.

+ Left AMA—If the patient was registered to be seen but left

prior to being seen by a health care provider or left against

medical advice (AMA), this patient is still included in the

sample.

+ No followup planned—No return visit or telephone contact is

scheduled or planned for the patient’s problem on this visit.

+ Other—Any other disposition of the case not included in

the categories above.

Disposition (OPD)—Hospital staff were instructed to

mark all categories that apply.

+ Return to clinic PRN—The patient is instructed to return

to the clinic as needed.

+ Return to clinic-appointment—The patient is told to schedule an appointment or is given an appointment to return to

the clinic at a particular time.

+ Telephone followup planned—The patient is instructed to

telephone the physician or other clinic staff on a particular

day to report on his or her progress, or to call at any time

if he or she has a problem or wishes further consultation.

+ Return to referring physician—The patient was referred to

this clinic by his or her personal physician or some other

physician and is now instructed to consult again with the

physician who made the referral.

+ Refer to other physician/clinic—The patient is instructed

to consult or seek care from another physician or clinic.

The patient may or may not return to this physician or

clinic at a later date.

+ Admit to hospital—The patient is instructed that further

care or treatment will be provided as an inpatient in the

hospital.

+ No followup planned—No return visit or telephone contact

is scheduled or planned for the patient’s problem on this

visit.

+ Other, specify—Any other disposition of the case not

included in the categories above.

Providers—Hospital staff were instructed to mark all

providers seen by the patient during this visit.

+ Resident/intern—Persons graduated from medical school

and in training.

+ Staff physician—Physician who is employed by the hospital or the university affiliated with the hospital and is a

member of the hospital staff.

+ Other physician—Consulting physicians and other parttime physicians who are not considered to be members of

the hospital staff.

+ Physician assistant—Certified health care professional

who delivers health care services under the supervision of

a licensed physician.

+ Nurse practitioner—Registered nurse with advanced training who provides primary health care services. Supervision by a physician is required in some states.

+ Registered nurse—Self-explanatory.

+ Licensed practical nurse—Self-explanatory.

+ Nurse’s aide—Self-explanatory.

86
Appendix III

Survey instruments

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90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
Vital and Health Statistics

series descriptions

SERIES 1. Programs and Collection Procedures—These reports

describe the data collection programs of the National Center

for Health Statistics. They include descriptions of the methods

used to collect and process the data, definitions, and other

material necessary for understanding the data.

SERIES 2. Data Evaluation and Methods Research—These reports

are studies of new statistical methods and include analytical

techniques, objective evaluations of reliability of collected

data, and contributions to statistical theory. These studies also

include experimental tests of new survey methods and

comparisons of U.S. methodology with those of other

countries.

SERIES 3. Analytical and Epidemiological Studies—These reports

present analytical or interpretive studies based on vital and

health statistics. These reports carry the analyses further than

the expository types of reports in the other series.

SERIES 4. Documents and Committee Reports—These are final

reports of major committees concerned with vital and health

statistics and documents such as recommended model vital

registration laws and revised birth and death certificates.

SERIES 5. International Vital and Health Statistics Reports—These

reports are analytical or descriptive reports that compare U.S.

vital and health statistics with those of other countries or

present other international data of relevance to the health

statistics system of the United States.

SERIES 6. Cognition and Survey Measurement—These reports are

from the National Laboratory for Collaborative Research in

Cognition and Survey Measurement. They use methods of

cognitive science to design, evaluate, and test survey

instruments.

SERIES 10. Data From the National Health Interview Survey—These

reports contain statistics on illness; unintentional injuries;

disability; use of hospital, medical, and other health services;

and a wide range of special current health topics covering

many aspects of health behaviors, health status, and health

care utilization. They are based on data collected in a

continuing national household interview survey.

SERIES 11. Data From the National Health Examination Survey, the

National Health and Nutrition Examination Surveys, and

the Hispanic Health and Nutrition Examination Survey—

Data from direct examination, testing, and measurement on

representative samples of the civilian noninstitutionalized

population provide the basis for (1) medically defined total

prevalence of specific diseases or conditions in the United

States and the distributions of the population with respect to

physical, physiological, and psychological characteristics, and

(2) analyses of trends and relationships among various

measurements and between survey periods.

SERIES 12. Data From the Institutionalized Population Surveys—

Discontinued in 1975. Reports from these surveys are

included in Series 13.

SERIES 13. Data From the National Health Care Survey—These

reports contain statistics on health resources and the public’s

use of health care resources including ambulatory, hospital,

and long-term care services based on data collected directly

from health care providers and provider records.

SERIES 14. Data on Health Resources: Manpower and Facilities—

Discontinued in 1990. Reports on the numbers, geographic

distribution, and characteristics of health resources are now

included in Series 13.

SERIES 15. Data From Special Surveys—These reports contain

statistics on health and health-related topics collected in

special surveys that are not part of the continuing data

systems of the National Center for Health Statistics.

SERIES 16. Compilations of Advance Data From Vital and Health

Statistics—Advance Data Reports provide early release of

information from the National Center for Health Statistics’

health and demographic surveys. They are compiled in the

order in which they are published. Some of these releases

may be followed by detailed reports in Series 10–13.

SERIES 20. Data on Mortality—These reports contain statistics on

mortality that are not included in regular, annual, or monthly

reports. Special analyses by cause of death, age, other

demographic variables, and geographic and trend analyses

are included.

SERIES 21. Data on Natality, Marriage, and Divorce—These reports

contain statistics on natality, marriage, and divorce that are

not included in regular, annual, or monthly reports. Special

analyses by health and demographic variables and

geographic and trend analyses are included.

SERIES 22. Data From the National Mortality and Natality Surveys—

Discontinued in 1975. Reports from these sample surveys,

based on vital records, are now published in Series 20 or 21.

SERIES 23. Data From the National Survey of Family Growth—

These reports contain statistics on factors that affect birth

rates, including contraception, infertility, cohabitation,

marriage, divorce, and remarriage; adoption; use of medical

care for family planning and infertility; and related maternal

and infant health topics. These statistics are based on

national surveys of childbearing age.

SERIES 24. Compilations of Data on Natality, Mortality, Marriage,

Divorce, and Induced Terminations of Pregnancy—

These include advance reports of births, deaths, marriages,

and divorces based on final data from the National Vital

Statistics System that were published as supplements to the

Monthly Vital Statistics Report (MVSR). These reports provide

highlights and summaries of detailed data subsequently

published in Vital Statistics of the United States. Other

supplements to the MVSR published here provide selected

findings based on final data from the National Vital Statistics

System and may be followed by detailed reports in Series 20

or 21.

For answers to questions about this report or for a list of reports published

in these series, contact:

Data Dissemination Branch

National Center for Health Statistics

Centers for Disease Control and Prevention

6525 Belcrest Road, Room 1064

Hyattsville, MD 20782

(301) 436–8500

E-mail: nchsquery@nch10a.em.cdc.gov

Internet: http://www.cdc.gov/nchswww/nchshome.htm
DHHS Publication No. (PHS) 96-1786, Series 13, No. 125

6-0505 (12/96)

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