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From Vital and Health Statistics of the National Center for Health Statistics Number 109 � May 23, 1985 

-* 

PROPERW OF ~~ ‘ 

PUBLfCATfONSBRANCH 

EDfTOR!ALU13FW#Y 

Hospital Use by Children: 

United States, 1983 

by Eileen McCarthy and Lola Jean Kozak, Division of Health Care Statistics 

Introduction 

During 1983 an estimated 3.7 million children under 

15 yeas of age were discharged from short-stay non-Federal 

hospitals in the United States. They spent an average of 

4,6 days in the hospital. These and other statistics presented 

in this report are based on data collected by the National 

enter for Health Statistics, by means of the National Hospital 

ischarge Survey, a continuous voluntary survey. In 1983 

a ata for the survey were abstracted tlom the medical records 

of approximately 206,000 patients discharged form 418 participating hospitals. A brief description of the sample design, 

source of data, and definition of terms used can be found 

in the Technical notes. The design of the survey has been 

described in a published report. 1 

Although other reports ‘q based on the 1983 survey 

include data on children under 15 years of age, this report 

contains data on the four age groups within the under 15 

years group: under 1 year, 14 years, 5–9 years, and 10-14 

years. Data for the age groups are presented by selected 

characteristics of dkcharges, diagnoses, and procedures. Estimates of the number of discharges, rates per 1,000 population, 

and average lengths of stay are shown for children. Summary 

statistics for 1973 and 1978 are also presented. This is 

the first detailed presentation of data from the survey on 

the four specific age groups of children. The report is also 

intended to update the U. S data from an earlier comparative 

study, “Hospital Use by Children in the United States and 

Canada,”5 which was based on 1978 data. 

Data for newborn infants are excluded from this report. 

The diagnostic and procedural data are coded according to 

the International Classification of Diseases, 9th Revision, 

Clinical Modification (ICD-9-CM).6 

Highlights 

The discharges of children under 1 year of age increased


from 15 percent of all children’s discharges in 1973 to


26 percent in 1983.


In 1983 males had a higher rate of discharges than females


for the age groups under 1 year, 1-4 years, and 5–9


years.


The average length of stay for children did not differ


significantly by sex or geographic region.


By region, the South had the largest number of children’s


discharges, an estimated 41 percent of the total.


Private insurance was the leading principal expected source


of payment of hospital costs for children.


Medicaid and the self-pay category were more likely to


be the expected source of payment for children under


1 year of age and 1-4 years than for older children.


Diseases of the respiratory system accounted for a fourth


of the discharges for children under 1 year of age, more


than a third of the hospitalizations for children 1-4 and


5–9 years, and 20 percent of the discharges for the 10-14


years age group.


Disorders relating to short gestation and unspecified low


birth weight was a major diagnosis for children under


1year of age.


Pneumonia was an important diagnosis for children 14


years; and chronic disease of tonsils and adenoids was


important for children 5–9 years and 10-14 years of age.


For children under 15 years of age, tonsillectomies with


or without adenoidectomies were the most frequently per-


formed procedures, followed by myringotomies.


o 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service 
2 advancedata 

Table 1. Numbers, ratea, and average lengths of stay for patients under 15 yesrs of age (excluding newborn infants) discharged from short-stay 

non-Federal hoapitel~ by age groups and sex United 8tates, 1973, 1978, and 1983 

1973 

Age group Both sexes Male Female Both sexes 

~~ ‘eMae ===-==0 

Number of discharges 

Under 15 years . . . . . . . . . . . . 3,933 2,231 1,700 3,488 1,946 1,542 3,654 2,084 1,570 

Under l year . . . . . . . . . . . . . . 580 337 243 691 394 297 936 542 394 

l-4 years.........,,.. . 1,214 703 510 1,044 601 443 1,146 664 482 

S9 years . 1,138 639 499 910 506 404 769 451 319 

10-14years . . . . . . . . . . . 1,001 552 448 843 445 398 803 427 375 

Rate per 1,000 population 

Under 15years . . . . . . . . . . . . . . . 70.0 77.9 61.8 67.1 73.3 60.7 70.8 79.0 62.3 

Under l year . . . . . . . . . . 185.6 211.0 158.5 207.7 231.6 182.6 255.8 289.2 220.7 

l-4years 88.4 100.3 75.9 84.2 94.7 73.1 80.9 91.7 69.6 

5-9years 62.2 68.5 55.7 52.6 57.3 47.7 48.1 55.1 40.8 

10-14years . . . . . . . . . . . . 47.6 51.5 43.5 44.5 46.0 43.0 45.1 47.0 43.2 

Average length of etay in days 

Under 15years . . . . . . . . . . 4.5 4,5 4.6 4.4 4.5 4.4 4,6 4.5 4.6 

Under l year . . . . . . . . . . . 6.4 6,2 6.7 5.9 5.7 6.2 6.6 6.5 6.7 

l-4years . . 4.3 4.1 4.6 4.0 4.0 4.0 3.7 3.6 3.7 

5-9years . . 3.8 3,8 3.7 3.6 3.7 3.4 3.4 3.4 3.3 

10–14years . . . . . . . . . . . 4.6 4.6 4.6 4.7 4.9 4.5 4.6 4.6 4.7 

Children’s discharges 

Trends byageand sex 

The 3.8 million discharges for children under 15 years 

of age in 1983 translated to a rate of 70.8 per 1,000 children 

in the population (table 1). Neither the total number nor 

the rate changed significantly from 1973 through 1983, but 

therewerechanges duringthisperiod forspecific agegroups. 

Children under 1 year of age, who had the highest 

discharge rates of the four children’s age groups, were the 

only agegroup for which the numbers and rates of discharges 

increased. They accounted for 15 percent of children’s discharges in 1973, expanded to 20 percent in 1978, and to 

26 percent in 1983. The discharge rate for children in this 

age group grew 38 percent from 1973 through 1983. The 

1-4 years age group made up virtually the same proportion 

of the discharges, approximately 30 percent, in each of 

the 3 years. 

The hospitalizations of children 5–9 years of age decreased during the period 1973–83. This group made up 

29 percent of children’s discharges in 1973, but fell to 26 

percent in 1978, and to 21 percent in 1983. The discharge 

rate of the 5–9 years age group decreased 23 percent during 

the period, with the rate for males declining 20 percent 

and the rate for females falling 27 percent. The number 

of discharges forchiklren 10-14 years of age also decreased. 

Children in this group accounted for 25 percent of all children’s 

discharges in 1973,22 percent in 1983. 

Neither the total average length of stay for all children 

under 15 years nor the lengths of stay for the four specific 

age groups changed significantly from 1973 through 1983. 

The longest lengths of stay were for children under 1 year 

of age. The 5–9 years age group had lengths of stay below 

theaverage forallchildren in 1973, 1978, and 1983. 

Average lengths of stay were approximately the same 

for both males and females in all the age groups in the 

period 1973–83. However, discharge rates were higher for 

males than for females under 15 years throughout the period 

Not all the sex differences in discharge rates for the specifi - a age groups were significant, but males had consistently higher 

discharge rates than females in the 1-4 years age group. 

In 1983 males also had higher discharge rates than females 

in the under 1 year and 5–9 years age groups. 

Geographic distribution 

The South Region of the country had the largest number 

of children’s discharges in 1983 (table 2). Although the 

South had the largest population of children of any region, 

this high number of discharges also reflects a children’s 

discharge rate that was higher than the average for all the 

regions. In two of the three geographic divisions that make 

up the region, East South Central and West South Central, 

the discharge rates were higher than the average. 

The North Central Region had the second highest population of children and the second highest number of children’s 

discharges. Within the region, the West North Central Division 

had a discharge rate that was higher than the average. 

The third-ranking region in number of discharges was 

the Northeast, even though it had the smallest regional population of children. The New England Division of this region 

had the smallest number of children’s discharges of any 

division because of its small population of children and a 

discharge rate for children that was well below the average 

for the country. Among the regions, the West had the smalles 

number and rate of children’s discharges. This is primarily o 

attributable to the very low discharge rate for the Pacific 

Division of the region. Lengths of stay for children by region 
achncedata 3 

Table 2. Number= rateq and average lengths of stay for patients under 15 years of age (excluding newborninfants)dischargedhornshoti-stsy non-Federalhoapitsl~ by geographic regions and dwisions United Stste$ 1983 

Rate per 1,000 Average length 

Region and division Number in thousands population of stay in days 

All regions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,654 70.8 4.6 

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 682 68.8 4.5 

New England . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 50.9 4.5 

Middle Atlantic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 557 74.7 4.5 

North Central . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 987 74.5 4.8 

EastNorth Central . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 622 66.6 4.9 

West North Central . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365 93.2 4.5 

South . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,507 83.9 4.6 

South Atlantic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 511 62.7 4.3 

EastSouth Central . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 384 110.8 4.3 

WestSouth Central . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 612 96.5 5.1 

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 478 45.7 4.0 

Mountain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194 62.6 4.0 

Pacific . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284 38.5 4.1 

Table3. Numkrs, percent tiWnbutmn~ andavemge len@sof sky forpatienk under 15years ofage(excludng newbrninfank) dschargedtiom 

shorkstaynon- Federslhospitsls, bye~edpnncipal wurcesof pa~entand agegroup~Unfied Shtes, 1983 

Source of payment Under 15 years Under 1 year 14 years 5-9 years lG14years 

Number of discharges 

-etal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,654 936 1,146 769 803 

edicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 801 246 288 139 126 

Privateinsurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,295 485 692 542 575 

Selfpay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325 129 96 47 51 

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233 74 66 41 51 

Percent distribution 

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 100.0 100.0 

Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21.9 26.5 25.1 18.1 15.7 

Privateinsurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62.8 51.6 60.4 70.5 71.7 

Selfpay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.9 13.8 8.5 6.2 6.3 

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.4 8.0 5.9 5.2 6.3 

Average length of stay in days 

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.6 6.6 3.7 3.4 4.6 

Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.0 6.8 4.2 3.6 5.0 

Privateinsurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.2 5.9 3.4 3.3 4.6 

Selfpay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.2 7.4 3.7 3.3 4.4 

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.7 8.5 4.4 4.5 4.3 

@ 

were not significantly different from the average for the 

country as a whole. 

Sourceofpayment 

The expected principal sources ofpayment forchildren’s 

hospitalizations are shown in table 3. Private insurance was 

e leading expected source for children in each of the four 

e groups. It was the expected source of payment for more 

an 70 percent of the hospitalizations of children 5–9 and 

10-14 years ofage and a smaller proportion ofthehospitalizations of children 1-4 years and under 1 year, 60 percent 

and 52 percent respectively. 

Medicaid, a government health program that provides 

benefits tolow-income persons, was the secondmostcommon 

expected source of payment for children. It was more likely 

to be the expected principal source of payment for children 

under 1 year and 14 years of age than for children in 

thetwoolderage groups. 

The self-pay category is onein which thecostsofhospitalization are expected to be paid by the family rather 

than anyinsurance or other program. More of thehospitaIizations of children under 1 year, 14 percent, fell into this 

category thandld hospitalizations ofother age groups, though 

children 14 years of age were more likely to have hospital 
stays in the self-pay category than were older children. 

The average length of stay varied somewhat for hospitalizations with different expected principal sources of payment. 

For children under 15 years of age as a group, average 

stays were shorter when private insurance was the payment 

source than when Medicaid or self pay were. Children under 

1 year in the self-pay category had significantly longer average 

stays than those covered by private insurance. The 1-4 years 

age group had significantly longer stays when covered by 

Medicaid than when covered by private insurance. However, 

for children 5–9 and 10-14 years of age, average stays 

were not significantly different for these three payment 

sources. 

Diagnoses 

Under 1 year of age 

Estimates of numbers and rates of discharges and of 

the average lengths of stay for children under 1 year of 

age are shown in table 4 by selected diagnoses and sex. 

Three diagnostic categories accounted for 61 percent of the 

discharges of children in this age group: diseases of the 

respiratory system, certain conditions originating in the 

perinatal period, and diseases of the digestive system. 

Diseases of the respiratory system were responsible for 

one-fourth of the discharges of the under 1 year age group. 

Acute bronchitis and bronchiolitis, other acute respirato~ 

infections, and pneumonia accounted for more than threefourths of the respiratory disease discharges. 

Certain conditions originating in the perinatal period made 

up 22 percent of the total discharges. Disorders relatiru? 

to short ‘gestation and unspecified low birth weight accounte 

for 42 percent of the discharges in the category. It shoul 

be pointed out that babies who remain in the hospital whereo 

they are born are categorized as newborn infants and are 

not included in this report. However, infants admitted or 

transferred to another hospital at any time after birth are 

considered patients under 1 yeax of age in the hospital to 

which they are admitted or transferred. This latter group, 

made up mainly of very young babies, accounts for a large 

proportion of discharges in the perinatal conditions category. 

Diseases of the digestive system made up 14 percent 

of the total discharges of children under 1 year of age. 

Two diagnoses accounted for three-fourths of the digestive 

disease discharges: noninfectious enteritis and colitis (54 percent) and inguinal hernia (22 percent). 

The discharge rate for males under 1 year was almost 

a third larger than the rate for females, and the differences 

in rates by sex were even larger for some of the diagnostic 

categories, For example, the discharge rate for diseases of 

the respiratory system was 49 percent higher for males, and 

within the category, males had a 73-percent higher rate for 

other acute respiratory infections. Males also had a 47-percent 

higher discharge rate for diseases of the digestive system 

and made up 89 percent of the discharges for inguinal hernia. 

The average length of stay for the under-1-year age 

group was 6.6 days, ranging from 1.7 days for inguinal 

hernia to 19.5 days for disorders relating to short gestatio 

oTable 4. Numbers, rates, and average lengths of stay for patienta under 1 year of age (excluding newborn infanta) discharged from short-stay 

non-Federal hospitals, by selected first-listed diagnoses and aex United Statesj 1983 

Diagnostic cateaofv and Both Both Both 

7C>%CM ;ode’ sexes Male Female sexes Male Female sexes Male Female 

Rate per 1,000 Average length of stay 

Number in thousands population in days 

. . . . . .. 9

Total, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 936 542 394 255.8 LOY.L LLU. f 6.6 6.5

Infectious and parasitic diseases . . . . . . . 001-139 

Oiseases of the nervous system and sense organs . 320-389 

OWis media and eustachian tube disorders . . . . .381,382 

Oiseases of the respiratory system . . . . . 460-519 

Acute bronchitis and bronchiolitis . . . . . . . . . 466 

Other acute respiratory infections . . 460465 

Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...480-486 

Diseases of the digestive system . . 520-579 

Inguinal hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...550 

Noninfectious enteritis and colitis 555-558 

Congenital anomalies . . . . . . . . . . . . . . . . . . . . . . . . . ..74C-759 

Certain conditions originating in the perinatal period . . . . . . . . 760-779 

Disorders relating to shorl gestation and unspecified low birth weight . 765 

Intrauterine hypoxia, birth asphyxia, and other respiratory conditions 

of newborn . . . . . . . . . . . . . . . . . . . . . . . . . . . ...768-770 

Hemolytic disease of fetus or newborn due to isoimmunization and 

other perinatal jaundice . . . . . . . . . . . . . . . . . . . . . ...773-774 

Symptoms, signs, and illdefined conditions . . . . . . . 760-799 

Injury and poisoning . . . . . . . . . . . . . . . . . . . . . . . . ...800-999 

Injuries (including fractures) . . . . . . . . . . . 80(!-959 

75 41 34 

61 32 29 

33 17 16 

237 144 92 

62 37 24 

46 31 17 

76 4.4 32 

127 77 50 

27 24 ‘ 

69 35 33 

75 45 30 

206 115 90 

86 49 38 

35 21 14 

33 20 14 

32 19 13 

29 17 12 

20 12 “9 

20.4 21.8 19.0 4.9 4.5 5.4 

16.7 17.1 16.4 5.2 6.1 4.1 

6.9 9.0 8.9 3.3 3.2 3.3 

64.6 77.0 51.6 4.5 4.6 4.4 

16.8 20.0 13.5 4.6 4.5 4.8 

13.2 16.6 9.6 3.3 3.5 2.9 

20.7 23.2 18.1 5.2 5.3 4.9 

34.6 41.0 27.9 3.9 3.8 4.1 

7.5 12.6 1.7 1.6 

18.7 18.7 16.8 4.3 4.5 4.0 

20.4 23.9 16.7 6.3 6.0 6.7 

56.2 61.6 50.5 12.8 12.7 13.0 

23.6 26.0 21.1 19.5 19.9 19.0 

9.5 11.2 7.6 12.1 9.5 16.2 

9.1 10.6 7.6 3.0 3.0 3.0 

8.8 10.4 7.2 4.1 4.2 

7.9 9.1 6.7 4.3 3.5 

5.5 6.2 *4.8 4.5 4.0 

* � 

1aaaed on the /nfernafiona/C/assifica/ionof Diseases,9th Revision,C/irrica/Modification(lCO-S-CM). 

21ncludesdiagnostic renditions no?shown in table. 

6.7 
�

and unspecified low birth weight. A much longer than average 

stay, 12.8 days, was recorded for “certain conditions originatg in the perinatal period.” This category contained not 

m Iy the disorders relating to short gestation and unspecified 

low birth weight but intrauterine hypoxia and other respiratory 

condhions of the newborn, for which the average length 

of stay was 12.1 days. On the other hand, the length of 

stay for hemolytic disease of newborn due to isoimmunization 

and other perinatal jaundice was only 3.0 days, well below 

the average for all conditions. 

In most diagnostic categories the average lengths of stay 

for males and females under 1 year varied by less than 

1 day. There were some exception% though. The stays of 

males were 2 days longer than stays of females for diseases 

of the nervous system and sense organs. Females had stays 

1.9 days longer for injury and poisoning and 6.7 days longer 

for intrauterine hypoxia and other respiratory conditions of 

the newborn. 

14 years of age 

Children 14 years of age had a total of 1.1 million 

discharges in 1983 (table 5). A greater number of these 

discharges were for diseases of the respiratory system, 

420,000 (37 percent), than for any other diagnostic category. 

Every fourth diagnosis in the respiratory disease category 

for this age group was pneumonia. Other acute respiratory infections contributed an additional 21 percent of the 

espiratory disease diagnoses. Chronic disease-of tonsils and 

able5. Numbersj rate%and average lengths of stay for patients under 1-4 

ack3ncedata 5 

adenoids and asthma were also important diagnoses for this 

age group, accounting for 18 and 15 percent, respective] y, 

of the discharges for respiratory diseases. 

Three categories were very similar in importance as 

discharge diagnoses for the 14 years age group, each making 

up 12 percent of total discharges. One category was “diseases 

of the nervous system and sense organs .“ The major diagnosis 

within this category was otitis media and eustachian tube 

disorders, which was responsible for 63 percent of the discharges in the category. The second category, diseases of 

the digestive system, also had one main diagnosis, noninfectious enteritis and colitis, which accounted for 53 percent 

of the discharges in the category. Almost half of the third 

category, injury and poisoning, was made up of discharges 

for a variety of injuries (other than fractures), such as concussions, sprains, lacerations, and bums. 

The discharge rate for males 14 years of age was 

almost one-third larger than the rate for females. In the 

largest diagnostic category, diseases of the respiratory system, 

the male discharge rate was 50 percent higher than the 

female rate. Within the catego~, the sex difference was 

particularly marked for chronic disease of tonsils and 

adenoids, for which the male discharge rate was 65 percent 

higher. Males also made up 71 percent of the discharges 

for chronic and unspecified bronchitis. 

In addition, a &eater than average sex difference in 

discharge rates was found for the “diseases of the digestive 

system.” The male rate was 44 percent higher for the category 

yeara of age d~arged from short-stay non-Federslhospitsfs,by selected 

first-listed d~noses end sex United Stste~ lb 

Diagnostic categoty and Both Both Both 

ICD-S41U code~ sexes Male Female sexes Male Female sexes Male Female 

Rate per 1,000 Average length of stay 

Number in thousands population in days 

TotalZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,146 664 482 80.9 91.7 69.6 3.7 3.6 3.7 

Infectious and parasitic diseases . . . . . . . . . . . . . . . . . . . . 001-139 68 37 31 4.8 5.1 4.5 4.0 4.0 3.9 

Diseases of the nervous system and sense organs . . . . . . . . . . . 320-389 137 76 61 9.7 10.4 8.9 3.0 2.9 3.1 

Disorders of the central nervous system. . . . . . . . . . . 320-336,341M349 22 12 11 1.6 1.6 1.5 7.0 7.0 7.1 

Otitis media and eustachian tube disorders . . . . . . . . . . . . . . .381,382 86 49 37 6.1 6.6 5.4 2.2 2.2 2.3 

Diseases of the respiratory system. . . . . . . . . . . . . . . . . . . 460-519 420 257 164 29.7 35.4 23.6 3.3 3.3 3.3 

Acute bronchitis and bronchiolitis . . . . . . . . . . . . . . . . . . . . . . 466 38 24 14 2.7 3.3 2.1 3.3 3.2 3.5 

Other acute respiratory infections . . . . . . . . . . . . . . . . . . . 460+65 90 56 34 6.3 7.7 4.9 2.9 2.8 2.9 

Chronic disease of tonsils and adenoids . . . . . . . . . . . . . . . . . . 474 75 48 27 5.3 6.6 4.0 1.7 1.7 1.6 

Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...480-486 105 61 45 7.4 8.4 6.5 4.4 4.6 4.3 

Bronchitis, chronic and unspecified . . . . . . . . . . . . . . . . . . 490491 24 17 7 1.7 2.4 “0.9 3.4 3.3 “3.8 

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...493 62 34 27 4.4 4.7 4.0 3.5 3.5 3.5 

Diseases of thedigestivesystem . . . . . . . . . . . . . . . . . . . . 520-579 135 81 54 9.5 11.2 7.8 2.9 2.7 3.2 

Inguinal hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...550 26 21 “5 1.8 2.9 ‘0.7 1.6 1.6 1.4 

Noninfectious enteritis and cofitis . . . . . . . . . . . . . . . . . . . 555-558 71 39 32 5.0 5.4 4.6 3.3 3.4 3.3 

Diseases of the genitourinary system . . . . . . . . . . . . . . . . . . 580-629 44 21 23 3.1 2.9 3.3 3.6 3.8 3.4 

Congenital anomalies . . . . . . . . . . . . . . . . . . . . . . . . ...740-759 64 41 24 4.5 5.6 3.4 5.7 5.3 6.5 

Symptoms, signs, and ill-defined conditions . . . . . . . . . . . . . . . 780-799 24 14 10 1.7 2.0 1.4 3.1 2.9 3.4 

Injury and poisoning . . . . . . . . . . . . . . . . . . . . . . . . ...800-999 133 77 56 9.4 10.6 8.1 4.4 4.5 4.4 

Fractures, all sites . . . . . . . . . . . . . . . . . . . . . . . . . ..60C-629 26 15 11 1.8 2.1 1.6 7.0 7.5 6.3 

jurfesother than fractures . . . . . . . . . . . . . . . . . . . . . . 85C-959 64 37 27 4.5 5.0 4.0 3.8 4.3 3.2 

ased on the InternationalClasairicstkmof Dissa.ss, 9fh Revision, Clinical Modification (lCO-%CM). 

‘Includesdiagnosticrenditionsnot shownin table 
�

6 ackncedata 

as a whole. Within the category, males accounted for 81 

percent of the discharges for inguinal hernia. The male discharge rate was also 65 percent higher than the female 

rate for the congenital anomalies category. 

The average lengths of stay by diagnosis ranged from 

1.6 days to 7 days for children 14 years of age. Stays 

of less than 2 days were the average for both inguinal 

hernia and chronic disease of tonsils and adenoids. The 

average stays of 7 days were recorded for disorders of the 

central nervous system and fractures. Both the total average 

lengths of stay and the average stays for specific diagnoses 

were similar for males and females. 

5-9 years of age 

Table 6 shows hospital use by diagnostic categories for 

children 5–9 years of age. The respiratory disease category 

accounted for the largest number of discharges, 260,000, 

which was one-third of the total number of discharges for 

the children 5–9 years of age. Chronic disease of tonsils 

and adenoids was the most important diagnosis within the 

respiratory disease category. It made up almost half of 

respiratory disease diagnoses, and by itself was responsible 

for significantly more discharges than any of the other diagnostic categories except injury and poisoning. 

Injury and poisoning ranked second in importance among 

the diagnostic categories with 125,000 discharges, 16 percent 

of total discharges. Fractures accounted for 40 percent of 

the discharges in the category, and intracranial injuries, excluding those with skull fractures, made up an additional 18 

percent of the category. 

Other important diagnostic categories for the 5–9 years 

age group were diseases of the nervous system and sense 

organs with 10 percent of total discharges, and diseases 

of the digestive system with 11 percent. Otitis media a 

eustachian tube disorders made 

discharges for diseases of the 

organs. Noninfectious enteritis 

most a fourth of the discharges 

system. 

up more than half of th*

nervous system and sense 

and colitis accounted for alfor diseases of the digestive 

The discharge rate was 35 percent higher for males 

than for females 5–9 years of age. The sex difference was 

especially pronounced for the injury and poisoning category, 

in which the male discharge rate was 82 percent higher 

than the female rate. Within the category males had a 70 

percent higher discharge rate for fractures, and they accounted 

for more than three-fourths of the discharges for intracranial 

injury, 

The sex difference in discharge rates was also large 

for the congenital anomalies category, in which the male 

rate was 85 percent higher than the female rate. In addition, 

the male discharge rate was 57 percent higher for otitis 

media and eustachian tube disorders and 94 percent higher 

for asthma. 

The range in average lengths of stay for diagnostic 

categories was not wide, from 1.6 to 4.8 days. Stays of 

less than 2 days were the average for otitis media and eustachian tube disorders and for chronic disease of tonsils and 

adenoids. Average stays of more than 4.5 days were found 

for pneumonia and fractures. The average lengths of st 

of males and females were different by less than a c1 . 

m for all the diagnoses and diagnostic categories. 

Table 6. Numbers, rates, and average lengths of stay for patients 5-9 yeara of age discharged from short-stay non-Federai hospitala, by selected 

tirat-listed dmgnoaea and sex United States, 1983 

Diagnostic categofy and Both Both Both 

ICD-9-CM code’ sexes Male Female sexes Male Female sexes Male Female 

Rate per 1,000 Average length of stay 

Number in thousands population in days 

Total* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 769 451 319 46.1 55.1 40.8 3.4 3.4 3.3 

Infectious and parasitic diseases . . . . . . . 001-139 36 19 19 2.4 2.3 2.4 3.6 3.4 3.9 

Diseases of the nervous system and sense organs . . . 320-389 77 45 32 4.8 5.5 4.0 2.0 2.0 2.0 

~ltis media and eustachian tube disorders . . . . . . 381-382 43 27 16 2.7 3.3 2.1 1.6 1.5 1.8 

Oiseases of the respiratory system . . . . 460-519 260 148 113 16.3 18.1 14.4 2.8 2.9 2.6 

Acute respiratory infections . . . 460466 34 18 16 2.1 2.2 2.1 2.8 2.9 2.8 

Chronic diseases of tonsils and adenoids . . . . . . . . 474 127 67 60 7.9 6.2 7.7 1.6 1.9 1.7 

Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...480-486 40 23 17 2.5 2.9 2.2 4.8 4.6 4.6 

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...493 37 25 12 2.3 3.1 1.6 3.5 3.5 3.7 

Diseases of the digestive system . . . . . 520-579 68 49 39 5.5 6.0 4.9 3.5 3.6 3.5 

Noninfectious enteritis and mlitis . . . . 555-558 21 11 10 1.3 1.3 1.3 3.1 3.2 3.0 

Diseases of the genitourinary system . . . 560-629 32 14 17 2.0 1.8 2.2 3.5 3.8 3.3 

Congenital anomalies . . . . . . . . . . . . . . . . . . . . . . . . ...740-759 30 19 10 1.9 2.4 1.3 3.5 3.2 4.0 

Symptoms, signs, and ill-defined conditions . . . . . 780-799 16 10 9 1.2 1.2 “1.1 2.3 2.6 *2.1 

Injuty and poisoning . . . . . . . . . . . . . . . . . . . . . . . . ...600-999 125 62 43 7.8 10.0 5.5 4.1 4.0 4.2 

Fractures, all sites . . . . . . . . . . . . . . . . . . . . . . . . ...800-829 50 32 18 3.1 3.9 2.3 4.7 5.0 4. 

Intracranial injury, excluding those with skull fracture . 650-654 22 17 “5 1.4 2.1 “0.7 2.7 2.9 “2.2Q 

Other injuries . . . . . . . . . . . . . . . . . . . . . . ...830-648.660-959 39 24 15 2.4 2.9 1.9 4.2 3.9 4.7 

1Baaed on the /nternatima/ Classificationof Disesses, 9th Revision, C/inica/ Modification (lCD-S-CM). 

21ncludeadiagnostic conditions not shown in table. 
�

1*14 years of age 

Children 10-14 years of age had 803,000 hospital disharges in 1983 (table 7). There were more diagnostic 

o	 categories with sizable numbers of discharges for this age 

group than for the younger age groups. The following 

categories each accounted for more than 20,000 discharges 

for children 10-14 years but for less than 20,000 discharges 

for children in each of the other three age groups: neoplasms; 

endocrine, nutritional and metabolic diseases, and immunity 

disorders; diseases of the blood and blood- forming organs; 

mental disorders; and diseases of the musculoskeletal system 

and connective tissue. 

The leading diagnostic categories for the 10-14 years 

age group were diseases of the respiratory system and injury 

and poisoning, which were each responsible for 20 percent 

of all discharges. Chronic disease of tonsils and adenoids 

was again the most important respiratory disease diagnosis, 

making up 42 percent of all discharges in the category. 

Fractures accounted for 39 percent of the discharges in the 

injury and poisoning category. 

Diseases of the digestive system was the third-ranking 

diagnostic category in number of discharges. Fourteen percent 

of all discharges for children 10-14 years were in this category. 

Noninfectious enteritis and colitis was the most frequent diagnosis, making up 23 percent of the digestive disease category. 

The total discharge rates for males and females 10-14 

years of age were not significantly different, but sex 

admmedata 7 

differences were found in the rates for specific diagnoses 

and diagnostic categories. The discharge rate for chronic 

disease of tonsils and adenoids was 78 percent higher for 

females than for males. This difference is especially noteworthy because the rates for the diagnosis were higher for males 

14 years of age and were not significantly different by 

sex for children 5–9 years of age. However, for the injury 

and poisoning category the discharge rate of males 10-14 

years of age was almost twice the female rate. Within the 

category males had rates more than 1.5 times higher than 

females for fractures. They accounted for 69 percent of the 

discharges for intracranial injury, and had more than double 

the female rate for other injuries. 

The longest average length of stay for children 10-14 

years of age was 19.4 days for mental disorders. Lengths 

of stay for other diagnostic categories ranged between 6.3 

days for “endocrine, nutritional, and metabolic diseases and 

immunity disorders” and 2.9 days for “symptoms, signs, 

and ill-defined condhions” and “diseases of the respiratory 

system.” The shortest stay, 1.7 days, for chronic disease 

of tonsils and adenoids was within the respiratory disease 

category. 

The total average lengths of stay for males and females 

were not significantly different, but there were sex differences 

in the lengths of stay for specific conditions. The length 

of stay of females was twice that of males for diseases 

of the blood and blood-forming organs, and females had 

a able7. Numbe~ rete~ and average lengths of stay for patients 10-14 yeara of age discharged from short-stay non-Federaf hoapita@ by aeleoted 

ti-fisted dmgnoaes end aex Unitad State& 1983 

Diagnostic category and Both Both Bofh 

ICD-9-CM code’ sexes Male Female sexes Male Female sexes Male Female 

Rate per 1,000 Average length of stay 

Number in thousands population in days 

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 803 427 375 45.1 47.0 43.2 4.6 4.6 4.7 

Infectious and parasitic diseases . . . . . . . . . . . . . . . . . . . 001-139 28 14 14 1.6 1.5 1.6 3.6 3.8 3.4 

Neoplasm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239 27 17 10 1.5 1.8 1.2 3.6 2.7 5.1 

Endocrine, nutritional and metabolic diseases, and 

immunity cfisorders . . . . . . . . . . . . . . . . . . . . . . . . . . 240-279 26 12 14 1.5 1.3 1.6 6.3 5.1 7.3 

DLseases of the blood and blood-forming organs . . . . . . . . . . . . 280-289 24 12 12 1.3 1.3 1.4 4.2 2.8 5.6 

Mental disorders . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-319 36 17 19 2.0 1.9 2.2 19.4 17.7 21.0 

Diseases of the nervous system and sense organs . . . . . . . . . . . 320-389 38 21 17 2.1 2.3 2.0 3.6 3.5 3.7 

Diseases of the respiratory system . . . . . . . . . . . . . . . . . . . . 460-519 159 76 81 8.9 8.6 9.3 2.9 3.0 2.7 

Acute respiratory infections . . . . . . . . . . . . . . . . . . . . . 460-466 22 11 11 1.2 1.2 1.3 3.1 3.2 2.9 

Chronic diseases of tonsils and adenoids . . . . . . . . . . . . . . . . . . 474 66 24 42 3.7 2.7 4.8 1.7 1.6 1.6 

Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...460-466 21 13 8 1.2 1.4 “0.9 5.0 4.8 �5.3 

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...493 24 15 “9 1.3 1.6 ‘1.1 3.6 3.7 �3.5 

Diseases of the digestive system . . . . . . . . . . . . . . . . . . . 52C-579 111 62 49 6.2 6.8 5.6 4.1 3.9 4.3 

Noninfectious enteritis and colitis . . . . . . . . . . . . . . . . . . . .555-556 26 15 11 1.5 1.6 1.3 3.2 3.0 3.4 

oiSeaSeS of the genitourinary system . . . . . . . . . . . . . . . . . . 580-629 47 23 23 2.6 2.6 2.7 3.7 3.3 4.2 

Oiseases of the musculoskeletal system and connective tissue . . . . . 710-739 39 16 23 2.2 1.6 2.6 5.9 7.1 5.0 

Congenital anomalies . . . . . . . . . . . . . . . . . . . . . . . . ...740-759 23 13 11 1.3 1.4 1.2 5.8 6.9 4.6 

ymptoms, signs, and ill-defined conditions . . . . . . . . . . . . . . . 780-799 29 13 16 1.7 1.5 1.9 2.9 2.8 3.0 

jury and poisoning . . . . . . . . . . . . . . . . . . . . . . . . ...600-999 164 110 54 9.2 12.1 6.2 4.2 4.6 3.1 

a Fractures, all sites . . . . . . . . . . . . . . . . . . . . . . . . ...600-629 64 47 17 3.6 5.2 2.0 5.0 5.7 2.9 

Intracranial injury, excluding those with skull fracture . . . . . . . . . 850-654 26 18 ‘8 1.5 2.0 ‘0.9 3.6 4.0 ‘2.8 

Ofher injuries . . . . . . . . . . . . . . . . . . . . . . . ..63G648.860-959 54 38 17 3.1 4.2 1.9 3.7 3.9 3.3 

1Based on the htemationd Cksificatim of Diseases, 9fh Reviaimr, C/inics/ Modification (lCO-g-CM). 

21ncludea diagnostic conditions not shown in table. 
�

� 

8 ackincedata 

89 percent longer stays for neoplasms. Males had 50 percent 

longer stays for congenital anomalies and 55 percent longer 

stays for injury and poisoning. Within the injury and poisoning 

category, the average stays of males were almost twice those 

of females for fractures. 

Procedures 

In 1983, 2.3 million operations and other procedures 

were performed in hospitals on children under 15 years of 

age. Both the numbers and the rates of procedures were 

higher for males under 15 years than for females (tables 

8 and 9). Children under 1 year of age had the lowest 

number of procedures but the highest rate among the four 

age groups. The other age groups each accounted for about 

the same number of procedures, but the rate of procedures 

for children 10-14 years of age was significantly below 

the average for all children under 15 years. 

The largest number of procedures for children under 

15 years was in the category “operations on the nose, mouth, 

and pharynx,” which contained almost 20 percent of all 

procedures. Tonsillectomies with and without adenoidectomies 

were responsible for more than 60 percent of the procedures 

in this category. The other major procedure categories for 

children under 15 years were operations on the ear, more 

than three-fourths of which were myringotomies; operations 

on the digestive system, more than half of which were 

appendectomies and inguinal ‘hernia rep,airs; operations on 

the musculoskeletal system, 40 percent of which were reductions of fracture; and miscellaneous diagnostic and therapeut”” 

procedures, one-fourth of which were computerized axi 0 

topographies and diagnostic ukrasounds. 

The leading procedure categories for children under 1 

year of age were somewhat different than for the other three 

age groups. In addition to operations on the digestive system 

and miscellaneous diagnostic and therapeutic procedures, leading categories for these children were operations on the 

nervous system and operations on the cardiovascular system. 

The under- 1-year age group had higher rates than the other 

three age groups for all these procedure categories. They 

also had higher rates for cardiac catheterizations, repair of 

inguinal hernia, computerized axial tomography, and for spinal 

taps and biopsies of the nervous system, which accounted 

for 81 percent of the operations on the nervous system. 

The largest procedure category both for children 14 

and 5–9 years of age was operations on the nose, mouth, 

and pharynx. Tonsillectomies with and without adenoidectomies made up more than half of the procedures in the 

category for children 1-4 years of age, and almost threefourths for children 5–9 years, who had the highest rate 

for the procedure among the four age groups. Children 14 

and 5–9 years were the only age groups for which operations 

on the ear was a leading category. Myringotomies accounted 

for more than 90 percent of the ear operations on children 

Table 8. Number of all-fisted procedures for patients under 15 years of age (excluding newborn infants) discharged from shorkstay non-Federal hospitalm, 

by selected procedure categories, sexj and age groups United State% 1983 

Under 15 years 

Procedure category and 6oth Under 1-4 5-9 10-14 

ICD-9-CM code’ sexes Male Female 1 year years years years 

Number in thousands 

Total* . . . . . . . . . . . . . . . . . . . . . . 2,293 1,346 947 423 643 609 619 

Operations on the nervous system . . . 01-05 143 76 66 80 32 17 14 

Spinal tap and biopsies on the 

nervous system . . 01.1,03 .3,04.1,05.1 101 55 46 65 22 8 *6 

Operations on theear . . . 18-20 220 132 88 “9 95 91 25 

Myringotomy . . . . . . . . . . . . . . . . ...20.0 169 101 68 “7 66 66 10 

Operations on the nose, mouth, and pharynx . 21–29 451 239 213 12 139 178 i 22 

Tonsillectomy with or * without adenoidectomy . . . . . 28.2–28.3 279 143 136 78 130 71 . . Adenoidectomy without tonsillectomy 28.8 50 32 18 24 20 

Operations on the cardiovascular system . . 35-39 117 61 56 58 36 12 11 

* Cardiac catheterization . . . 37.21-37.23 32 16 16 11 12 “6 

Operations on the digestive system . 42–54 281 183 96 65 65 64 87 

Appendectomy, excluding incidental . 47.0 75 36 36 — 25 47 

Repair of inguinal hernia . . . . 53.0-53.1 61 67 13 28 28 17 *8 

Operations on the musculoskeletal system . . . 76-64 249 142 107 13 42 68 127 . Reduction of fracture . . . . . 76.7,79.0-79.8 100 66 34 12 38 46 

Operations on the integumentary system . . . 85-66 121 69 52 “6 37 32 45 

Excision or destruction of lesion or tissue 

“ of skin and subcutaneous tissue . . . . 86.2 30 16 14 “8 *7 13 

Miscellaneous diagnostic and 

therapeutic procedures . . . . . . 87-99 302 172 

Computerized axial 

130 91 71 55 85 � 

tomography . . 87.03,87.41,67,71,88,01 ,88.36 46 26 17 13 10 10 13 “ Diagnostic ultrasound . . . . . . . . 86.7 31 16 15 16 . “8 

1Bassd on the /nfemafimra/ C/assi?7cMm of Diseases, %h Revision, C/inics/ Modification (lCO-%CM) 

‘Includes procedures not shown in table. 
� 

� 

� 

� � 

� 

dvancedata 9 

Table9. Rates for aklisted prooedurea for patients under 15 yeare of age (exoluding newborn infants) discharged from short-stay non-Federal hospitals, 

by seleoted procedure ostegone~ ae~ and age group= United Stste~ 19S3 

Under 15 years 

Procedure category and Both Under 14 5-9 10-14 

ICD-9-CM codei sexes Male Female 1 year yeara years years 

TotalZ . . . . . . . . . . . . . . . . . . . . . . . . . . . 444.6 510.2 

Operations onthe nervous system. . . . . . . . 01-05 27.6 28.9 

Spinal tap and biopsies on the 

nervous system . . . . . . . . . 01.1,03 .3,04.1,05.1 19.5 20.7 

Operations on the ear . . . . . . . . . . . . . . 18-20 42.6 50.0 

Myringotomy . . . . . . . . . . . . . . . . . ..2o.o 32.7 36.1 

Operations on the nose, mouth, and pharynx . . 21-29 87.5 90.5 

Tonsillectomy with or 

without adenoidectomy . . . . . . . . . . 28.2-28.3 54.1 54.3 

Adenoidestomy without tonsillectomy . . . . . . 28.6 9.7 12.0 

Operations on the cardiovascular system . . . . 35-39 22.7 23.2 

Cardiac catheterization . . . . . . . . . . 37.21-37.23 6.2 6.0 

Operations on the digestive system . . . . . . . 42-54 54.5 69.4 

Appendectomy, excluding incidental . . . . . . . 47.o 14.5 14.6 

Repair of inguinal hernia . . . . . . . . . . 53.0-53.1 15.6 25.5 

Operations on the musculoskeletsl system . . . 76-84 48.3 53.9 

Reduotion of fraoture . . . . . . . . . . 76.7,79.0-79.6 19.4 24.9 

Operations on the integumenta~ system . . . . 85-86 23.5 26.0 

Excision or destruction of lesion or tissue 

of skin and subcutaneous tissue . . . . . . . . 86.2 5.6 6.0 

Miscellaneous diagnostic and 

therapeutic procedures . . . . . . . . . . . . . 87-99 58.5 65.3 

Computerized axial 

tomography . . . . . 87.03,87.41,87.71,68.01 ,88.38 8.8 10.7 

Diagnostic ultrasound . . . . . . . . . . . . . . 88.7 6.1 6.2 

Baesd on the /rrterrratiorra/ Cksirioation of Diseases, 9fh Revision, C/irrka/ A4c@hatiorr (lCD-%CM). 

— 21ncludes procedures not ahown in table. 

Rate per 10,000 population 

375.8 1,155.8 453.6 

26.3 219.0 22.4 

18.3 178.7 15.8 

34.8 ‘25.0 66.8 

26.9 ‘20.5 60.5 

84.3 33.2 96.0 

53.9 . 54.6 

7.3 17.1 

22.1 158.7 25.7 

6.5 30.3 6.5 

36.9 176.7 48.2 

14.4 

5.3 75.4 19.6 

42.5 35.2 29.3 

13.6 8.7 

20.8 ‘1 7.7 26.2 

. 5.7 “5.8 

51.5 246.2 50.0 

6.9 36.0 7.1 

6.0 43.5 

381.3 347.9 

10.3 7.9 

‘4.9 �3.1 

56.9 14.0 

41.2 5.4 

111.5 68.7 

81.5 39.7 * 12.6 

7.3 6.2 

‘3.6 

39.9 49.1 

15.6 26.7 

10.5 “4.7 

42.8 71.2 

23.8 26.8 

20.2 25.3 

‘4.1 7.2 

34.6 47.8 

“6.1 7.1 

‘4.7 

14 years and almost three-fourths on children 5–9 years. for more than half of the catego~ for the 5–9 years age 

The other leading procedure categories both for children 1-4 group, 38 percent for children 10-14 years of age. The 

and 5–9 years of age were operations on the digestive system other leading procedure categories for the 10-14 years age 

and miscellaneous diagnostic and therapeutic procedures. group were operations on the nose, mouth, and pharynx; 

Children 5–9 years of age also shared with children operations on the digestive system; and the miscellaneous 

10-14 years the leading procedure category “operations on category. This age group had a higher rate than the other 

the musculoskeletal system.” Reduction of ffactures accounted three for one procedure, appendectomy. 
---

� 

References 

a National Center for Health Statistics, W. R. Simmons and G. 

A. Schnack: Development of the design of the NCHS Hospital 

Dkcharge Survey. Vital and Health Statistics. Series 2, No. 39. 

DHEW Pub. No. (HRA) 77–1 199. Health Resources Administration. 

Washington. U.S. Government Printing Oftlce, May 1977. 

2National Center for Health Statistics, E. J. Graves: 1983 summary: 

National Hospital Discharge Survey. Advance Data From Vita[ 

and Health Statistics. No. 100. DHHS Pub. No. (PHS) 84-1250. 

Public Health Service. Hyattsville, Md., Sept. 28, 1984. 

3National Center for Health Statistics, E. J. Graves: Utilization 

of shofi-stay hospitals, United States, 1983, annual summary. Vital 

and Health Statistics. Series 13, No. 83. DHHS Pub. No. (PHS) 

85–1744. Public Health Service. Washington. U.S. Government 

Printing Office, Apr. 1985. 

4National Center for Health Statistics, L. J. Kozak and M. Moien: 

Detailed diagnoses and surgical procedures for patients discharged 

from short-stay hospitals, United States, 1983. Vital and Health 

Statistics. Series 13, No. 82. DHHS Pub. No. (PHS) 85-1743. 

Public Health Service. Washington. U.S. Government Printing Office, Mar. 1985. 

‘National Center for Health Statistics, L. J. Kozak and E. McCarthy: 

Hospital use by children in the United States and Canada. Vital 

and Health Statistics. Series 5, No. 1. DHHS Pub. No. (PHS) 

84-1477. Public Health Service. Washington. U.S. Government 

Printing Office, Aug. 1984. 

GWb]ic Health Semite and Health Care Financing Administration: 

International Classification of Diseases, 9th Revision, Clinical Modification. DHHS Pub. No. (PHS) 80-1260. Public Health Service. 

Washington. U.S. Government Printing Office, Sept. 1980. 

TNational Center for Health Statistics, M. G. Sirken: Utilization 

of short-stay hospitals, summary of nonmedical statistics, United 

States, 1965. Vital and Health Statistics. Series 13, No. 2. PHS 

Pub. No. 1000. Public Health Servic?. Washington. U.S. GovernmentPrinting Office, Aug. 1967. 

SNational Center for Health Statistics, M. J. Witkin: Utilization 

of short-stay hospitals by characteristics of discharged patients, 

United States, 1965. Vital and Health Sta~istics. Series 13, No. 

3. PHS Pub. No. 1000. Public Health Service. Washington. U.S. 

Government Printing Office, Dec. 1967. 

Symbols 

Data not available 

. . . Category not applicable 

Quantity zero 

0.0 Quantity more than zero but less than 

0.05 

z	 Quantity more than zero but less than 

500 where numbers are rounded to 

thousands 

Figure does not meet standard of 

reliability or precision 

#	 Figure suppressed to comply with 

confidentiality requirements 
Technical notes 

eurvey Methodology 

Source of data 

The National Hospital Discharge Survey (NHDS) encompasses patients discharged from short-stay hospitals, exclusive 

of military and Veterans Administration hospitals, located 

in the 50 States and the District of Columbia. Only hospitals 

with six or more beds and an average length of stay of 

less than 30 days for all patients are included in the survey. 

Discharges of newborn infants are excluded from this report. 

The original universe for the survey consisted of 6,965 

hospitals contained in the 1963 National Master Facility Inventory. New hospitals were sampled for inclusion in the survey 

in 1972, 1975, 1977, 1979, 1981, and 1983. In all, 553 

hospitals were sampled in 1983. Of these hospitals, 78 refused 

to participate, and 57 were out of scope. The418 participating 

hospitals provided approximately 206,000 abstracts of medical 

records. 

Sample design and data collection 

All hospitals with 1,000 or more beds in the universe 

of short-stay hospitals were selected with certainty in the 

sample. All hospitals with fewer than 1,000 beds were 

stratified, the primary strata being 24 size-by-region classes. 

ithin each of these 24 primary strata, the allocation of 

e hospitals was made through a controlled selection tech­

@ nique so that hospitals in the sample would be properly 

distributed with regard to type of ownership and geographic 

division. Sample hospitals were drawn with probabilities ranging from certainty for the largest hospitals to 1 in 40 for 

the smallest hospitals. 

Sample discharges were selected within the hospitals 

using the daily listing sheet of discharges as the sampling 

frame. These discharges were selected by a random technique, 

usually on the basis of the terminal digit or digits of the 

patient’s medical record number, a number assigned when 

the patient was admitted to the hospital. The within-hospital 

sampling ratio for selecting sample discharges varied inversely 

with the probability of selection of the hospital. 

The sample selection and the transcription of information 

nom the hospital records to abstract forms were performed 

by the hospital staff or by representatives of the National 

Center for Health Statistics or by both. The data were 

abstracted from the face sheets of the medical records. All 

discharge diagnoses and procedures were listed on the abstract 

in the order of the principal one, or the first-listed ohe 

if the principal one was not identified, followed by the order 

in which all other diagnoses or procedures were entered 

on the face sheet of the medical record. 

eresentation of estimates 

Statistics produced by NHDS are derived by a complex 

estimating procedure. The basic unit of estimation is the 

sample inpatient discharge abstract. The estimating procedure 

used to produce essentially unbiased national estimates in 

NHDS has three principal components: inflation by reciprocals 

of the probabilities of sampIe selection, adjustment for nonresponse, and ratio adjustment to fixed totals. These components 

of estimation are described in appendix I of two earlier 

publications.”s 

Based on consideration of the complex sample design 

of NHDS, the following guidelines are used for presenting 

NHDS estimates in this repo~. 

. If the sample size is less than 30, the value of the 

estimate is not reported. Only an asterisk (*) is shown 

in the tables. 

. If the sample size is 30-59, the value of the estimate 

is reported but should be used with caution. The estimate 

is preceded by an asterisk (*) in the tables. 

Sampting errors and rounding of numbers 

The standard error is a measure of the sampling variability 

that occurs by chance because only a sample, rather than 

an entire universe, is surveyed. The relative standard error 

of the estimate is obtained by dividing the standard error 

by the estimate itself and is expressed as a percent of the 

estimate. Relative standard errors for discharges and firstlisted diagnoses are shown in table I, relative standard errors 

for days of care are shown in table II, and relative standard 

errors for all-listed procedures are shown in table III. 

Estimates have been rounded to the nearest thousand. 

For this reason detailed figures within tables do not always 

add to the totals. Rates and average lengths of stay were 

calculated from original, unrounded figures and will not 

necessarily agree precisely with rates or average lengths 

of stay calculated from rounded data. 

Tablek @proximaterelativestandarderrors for estimated numbers of 

dmchargea and first-fisted diagn~ United Ststeq 1963 

Relative 

starrdard 

Size of estimate error 

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.0 

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.8 

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.1 

100,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.8 

300,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.3 

500,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.8 

1,000,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.2 

3,000,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.5 

5,000,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.2 

10,000,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.9 

20,000,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.7 

30,000,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.5 

40,000,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.5 
14 admncedata


Table 11: Approximate relative standard errore for estimated numbers of 

days of care, by region and all other characteristics 

United States, 1983 

Ail other 

Size of estimate Region characteristics 

10,000 . . . . . . . . . . . . . . . . 38.4 20.3 

30,000 . . . . . . . . . . . . . . . . 28.9 15.7 

50,000 . . . . . . . . . . . . . . . . . . . . 25.4 14.0 

100,000 . . . . . . . . . . . . . . . . . . . . . . 21.4 12.0 

300,000 . . . . . . . . . . . . . . . . . 16.5 9.5 

500,000 . . . . . . . . . . . . . . . . . . . . 14.7 8.6 

1,000,000. . . . . . . . . . . . . . . 12.6 7.5 

3,000,000. . . . . . . . . . . . . . . . . . . . . 10.0 6.2 

5,000,000. . . . . . . . . . . . . . . . . . . . 9.0 5.7 

10,000,000 . . . . . . . . . . . . . . . 7.9 5.1 

50,000,000 . . . . . . . . . . . . . . . . 5.9 4.0 

100,000,000 . . . . . . . . . . . . . . . . . . . 5.2 3.6 

200,000,000 . . . . . . . . . . . . . . 4.7 3.3 

Table Ill: Approximate relative standard errors for estimated numbers of 

all-listed procedures United States, 1983 

Relatjve 

standard 

Size of estimate error 

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17.1


10,000, . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.0


25,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.9


50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.2


100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.8


500,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.7


1,000,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1


3,000,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.3


5,000,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.0


10,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 3.6


15,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.5


20,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3


25,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,3


Testsofsignificance 

In this report, the determination of statistical inference 

is based on the two-tailed Bonfemoni test for multiple comparisons. Terms relating to differences such as “higher” and 

“less” indicate that the differences are statistically significant. 

Terms such as “similar” or “no difference” mean that no 

statistically significant difference exists between the estimates 

being compared. Alackofcomment onthedifference between 

any two estimates does not mean that the difference was 

tested and found to be not significant. 

Definitionofterms 

Hospitals—Short-stay general and special hospitals have 

six or more beds for inpatient use and an average length 

of stay of less than 30 days. Federal hospitals and hospital 

unitsofinstitutions are notincluded. 

Patient—A patient isaperson whois formally admitted 

to the inpatient service ofa short-stay hospital forobservation, 

care, diagnosis, or treatment. In this report the number of 

patients refers to the number of discharges during the year, 

including any multiple discharges of the same individual 

from one or more short-stay hospitals, Infants admitted on 

the day of birth directly or by transfer from another medical 

facility, with or without mention of disease, disorder, o 

immaturity, are included. All newborn infants, defined a 

those admitted by birth to the hospital, are excluded fromm 

this report. The terms “patient” and “inpatient” are used 

synonymously. 

Discharge—A discharge is the formal release of a patient 

by ahospital, that is, thetermination ofaperiodofhospitalization by death or by disposition to place of residence, nursing 

home, orotherhospital .Theterms ’’discharges” and’’patients 

discharged’’ areused synonymously. 

Discharge rate—The ratio of the number of hospital 

discharges during a year to the number of persons in the 

civilian population on July 1 of that year makes up the 

discharge rate. 

Average length of stay—The total number of days of 

care accumulated at the time of discharge by patients discharged during the year divided by the number of patients 

discharged forms the average length of stay. A stay of less 

than 1 day (patient admission and discharge on the same 

day) is counted as 1 day in the summation of total days 

of care. For patients admitted and discharged on different 

days, the number of days of care is computed by counting 

all days from (and including) the date of admission to (but 

not includhg) the date of discharge. 

Discharge diagnoses—One or more diseases or injuries 

(or some factor that influences health status and contact 

with health services which is not itself a current illnes 

or injury) listed by the attending physician on the medicala 

record of a patient constitute the discharge diagnoses. In 

NHDS all discharge (or final) diagnoses listed on the face 

sheet (summary sheet) of the medical record for patients 

discharged from the inpatient service of short-stay hospitals 

are transcribed in the order listed. Each sample discharge 

is assigned a maximum of seven five-digit codes according 

to ICD-9-CM.6 Thenumber ofprincipal or first-listed diagnoses is equivalent to the number of discharges. 

Principal diagnosis—The condition established after study 

to be chiefly responsible for occasioning the admission of 

the patient to the hospital for care is the principal diagnosis. 

First-listed diagnosis—The coded diagnosis identified as 

the principal diagnosis or listed first on the face sheet of 

the medical record if the principal diagnosis cannot be identified is the first-listed diagnosis. The number of first-listed 

diagnoses is equivalent to the number of discharges. 

Procedure—A procedure is one or more surgical or nonsurgical operations, procedures, orspecial treatments assigned 

by the physician to patients discharged from the inpatient 

service of short-stay hospitals. In NHDS all terms listed 

on the face sheet (summary sheet) of the medical record 

under the captions “operation,” “operative procedures,” “operations and/or special treatment,” and the like are transcribed 

in the order listed. A maximum of four procedures are coded. 

Rate ojprocedures—The ratio of the number of all-liste a procedures during a year to the number of persons in the 

civilian population on July 1 of that year makes up the 

rate of procedures. 
ackimecklta 15 

Age—Age refers to the age of the patient on the birthday Region and division .w2res 

prior to admission to the hospital inpatient service. 

Private insurance—Health insurance provided by nongovment sources includlng consumers, insurance companies, 

Northeast 

New England . . . Maine, New Hampshire, Vermont, 

Massachusetts, Rhode Island, Connecticut 

* rivate industry, and philanthropic organizations is private Middle Atlantic . . New York, New Jersey, Pennsylvania 

insurance. 

Notih Central 

Medicaid—Medicaid is a joint Federal-State welfare program available in virtually all States that provides medical East North Central . . 

West North Central . . 

Michigan, Ohio, Illinois, Indiana, Wkconsin 

Minnesota, Iowa, Missouri, North Dakota, 

benefits “forlow income persons, including the aged. In order South Dakota, Nebraska, Kansas 

to qualify for this program, a person must meet each State’s south 

definition of “low income.” 

Se~pay—The major share of the total costs for a self-pay 

South Atlantic . . . Delaware, Maryland, District of Columbia, 

Virginia, West Vkginia, North Carolina, 

hospitalization is expected to be paid by the patient, spouse, 

parents, or next of kin. 

East South Central . 

West South Central . 

South Carolina, Georgia, Florida 

Kentucky, Tennessee, Alabama, Mississippi 

Arkansas, Louisiana, Oklahoma, Texas 

Other payments—This includes all other sources of payment such as workmen’s compensation, Medicare, no charge, West 

and other government programs. Mountain . . . . . Montana, Maho, Wyoming, Colorado, 

New Mexico, Arizona, Utah, Nevada 

Geographic regions and divisions—The 50 States and Pacific . . . . . . . . Washington, Oregon, California, Hawaii, Alaska 

the District of Columbia are grouped by the Bureau of the 

Census into 4 regions and 9 divisions as follows: 
16 acklncedata


Recent Issues of Advance Data From Vital and Health Statistics 

No. 108. Wanted and Unwanted Childbearing: United States, No. 105. Diagnosis-Related Groups Using Data From the National 

1973-82 (Issued May 9, 1985) Hospital Discharge Survey: United States, 1982 (Issue’-

Jan. 18, 1985) 

No. 107. Marriage and First Intercourse, Marital Dissolution, and 

Remarriage: United States, 1982 (Issued Apr. 12, 1985) 

No. 106. Use of Topical Antimicrobial Drugs In Office-Based 

Practice: United States, 1980-81 (Issued Apr. 10, 1985) 

Suggested Citation 

National Center for Health Statistics, E. McCarthy and L. 

J. Kozak: Hospital use by children, United States, 1983. 

Advance Data From Wtal and Health Statistics, No. 109. 

DHHS Pub. No. (PHS) 85-1250. Public Health Service, 

Hyattaville, Md., May 23, 1985. 

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HUMAN SERVICES 

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Hyattsville, Maryland 20782 

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