NCHS Data Brief ■ No. 160 ■ July 2014

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Reasons for Emergency Room Use Among U.S. Children: 

National Health Interview Survey, 2012

Renee M. Gindi, Ph.D., and Lindsey I. Jones, M.P.H.

Key findings

Data from the National 

Health Interview Survey, 

2012

• In 2012, children with 

Medicaid coverage were more 

likely than uninsured children 

and those with private coverage 

to have visited the emergency 

room (ER) at least once in the 

past year.

• About 75% of children’s 

most recent visits to an ER in 

the past 12 months took place 

at night or on a weekend, 

regardless of health insurance 

coverage status.

• The seriousness of the 

medical problem was less 

likely to be the reason that 

children with Medicaid visited 

the ER at their most recent visit 

compared with children with 

private insurance.

• Among children whose 

most recent visit to the ER 

was for reasons other than the 

seriousness of the medical 

problem, the majority visited 

the ER because the doctor’s 

office was not open.

Emergency rooms (ERs) are intended to provide care for acute and 

life-threatening medical conditions for people of all ages, but use is highest 

among older adults and young children (1). In 2012, 18% of children aged 

0–17 years visited the ER at least once in the past year (2). Rising health 

care costs make it important to understand the reasons that families with 

children seek ER care, rather than less expensive office-based or outpatient 

care (3). Families visiting the ER at night or on weekends may have different 

characteristics or reasons for using the ER than those who visit during the day 

(4). Previous research among adults found that the majority visited the ER 

because “only a hospital could help,” or the “doctor’s office [was] not open” 

(5). This report provides comparable statistics on reasons for children’s ER 

use.

Keywords: health care utilization • health insurance

Children with Medicaid coverage were more likely to have 

at least one ER visit in the past year, compared with the 

uninsured and those with private coverage.

0

5

10

15

20

25

30

Private Medicaid Uninsured

Two visits

or more

One visit

Figure 1. Children aged 0–17 years with at least one emergency room visit in the past 12 

months, by health insurance coverage status: United States, 2012

1

Significantly different from children with Medicaid.

SOURCE: CDC/NCHS, National Health Interview Survey, 2012. 

1

10.0

15.0 1

11.2

1

2.9

9.8

1

Pe

4.5

rcent
NCHS Data Brief ■ No. 160 ■ July 2014

■  2  ■

In 2012, almost one in four children aged 0–17 with Medicaid coverage visited the ER at least 

once in the past 12 months (24.8%) (Figure 1). This was significantly higher than the percentage 

of uninsured children (15.7%) and the percentage of children with private insurance (12.9%) who 

visited the ER at least once in the past 12 months. This relationship was seen for both those 

visiting the ER only once and those visiting two times or more in the past 12 months.

For three in four children with an ER visit in the past 12 months, the most 

recent visit was at night or on a weekend, regardless of health insurance 

coverage status.

Among children with at least one ER visit in the past 12 months, almost 75% of the most recent 

ER visits were at night or on a weekend (Figure 2). This percentage was similar for children with 

private insurance (71.4%), Medicaid (75.4%), and those who were uninsured (75.0%).

Figure 2. Timing of most recent emergency room visit among children aged 0–17 years with an emergency room visit in

the past 12 months, by health insurance coverage status: United States, 2012

SOURCE: CDC/NCHS, National Health Interview Survey, 2012. 

0

20

40

60

80

100

All Private Medicaid Uninsured

Not night or

weekend

Night or

weekend 73.7 71.4 75.4 75.0

26.3 28.6 24.6 25.0

Percent
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Children with Medicaid were less likely than children with private insurance 

to visit the ER for reasons reflecting the seriousness of the medical 

problem.

Among privately insured children with at least one ER visit in the past 12 months, 67.9% of most 

recent ER visits were for a reason reflecting the seriousness of the medical problem, compared 

with 60.6% of children with Medicaid and 59.0% of uninsured children (Figure 3). Children with 

Medicaid (32.9%) who had at least one ER visit in the past 12 months were more likely than 

those with private insurance (26.4%) to visit most recently for a reason other than those reflecting 

the seriousness of the medical problem. No reasons were selected for a smaller percentage of 

most recent ER visits (6.5%).

Figure 3. Selected reasons for most recent emergency room visit among children aged 0–17 years with an emergency 

room visit in the past 12 months, by health insurance coverage status: United States, 2012

1

Significantly different from children with Medicaid.

NOTE: “Seriousness of medical problem” and “Other reason” are summaries based on positive responses to questions about reasons for emergency room visit. 

For details, see “Definitions” section of report. Categories are mutually exclusive.

SOURCE: CDC/NCHS, National Health Interview Survey, 2012. 

0 10 20 30 40 50 60 70 80

Uninsured

Medicaid

Private

All

No reason

selected

Other reason

Seriousness of

medical problem

5.8

1

26.4

1

67.9

6.5

32.9

60.6

11.7

29.3

59.0

6.5

30.0

63.5

Percent
NCHS Data Brief ■ No. 160 ■ July 2014

■  4  ■

Among those visiting the ER for reasons reflecting the seriousness of the 

medical problem, the most common reason was that only a hospital could 

help.

“Only a hospital could help” (79.1%) and “the problem was too serious for a doctor’s office” 

(62.0%) were the most common reasons for the most recent ER visit related to the seriousness of 

the medical problem among children aged 0–17 who had an ER visit reflecting the seriousness 

of the medical problem in the past 12 months (Figure 4). Of children who visited the ER for a 

reason reflecting the seriousness of the medical problem, privately insured children were the most 

likely to visit the ER because a health provider said to go (43.4%), compared with children with 

Medicaid (36.3%) and uninsured children (19.5%). Less than 10% of children’s most recent ER 

visits related to the seriousness of the medical problem were because the child arrived at the ER 

by ambulance.

9.6

1

43.4

65.4

77.0

8.1

1

36.3

58.6

80.4

*6.3

19.5

66.5

83.2

8.6

38.5

62.0

79.1

Figure 4. Selected reasons for most recent emergency room visit among children aged 0–17 years who had an

emergency room visit in the past 12 months for a reason reflecting the seriousness of the medical problem, by health

insurance coverage status: United States, 2012

1

Significantly different from uninsured children.

* Estimate has a relative standard error greater than 30% and less than or equal to 50% and is considered unreliable. Estimate should be used with caution.

NOTE: “Seriousness of medical problem” is a summary based on positive responses to any of the related detailed reasons included in this figure. Respondents 

could select more than one reason.

SOURCE: CDC/NCHS, National Health Interview Survey, 2012. 

Private

Medicaid

Uninsured

All

0 10 20 30 40 50 60 70 80 90 100

Arrived by

ambulance

Health provider

said to go

Problem too serious

for doctor's office

Only a hospital

could help

Percent
NCHS Data Brief ■ No. 160 ■ July 2014

■  5  ■

Among children whose most recent ER visit was for reasons other than 

those reflecting the seriousness of the medical problem, the most common 

reason was because their doctor’s office was not open.

Among children aged 0–17 whose most recent visit to the ER in the past 12 months was for a 

reason other than the seriousness of the medical problem, there were no significant differences in 

reasons by insurance type (Figure 5). The most common reason for the most recent ER visit was 

that the “doctor’s office [was] not open” (86.0%).

73.8

88.5

28.7

86.0

0 10 20 30 40 50 60 70 80 90 100

Most care at

emergency room

Emergency room is

closest provider

No other place to go

Doctor's office not open 83.9

54.9

51.7

66.9

53.7

26.8

29.2

36.7

5.4

*15.6

4.6

*

Figure 5. Selected reasons for most recent emergency room visit among children aged 0–17 years whose emergency 

room visit in the past 12 months was for a reason other than the seriousness of the medical problem, by health

insurance coverage status: United States, 2012

* Estimate has a relative standard error (RSE) greater than 30% and less than or equal to 50% and is considered unreliable. Estimate should be used with 

caution. Data not shown have an RSE greater than 50%.

NOTE: “Reasons other than seriousness of the medical problem” is a summary based on positive responses to any of the related detailed reasons included in this 

figure. Respondents could select more than one reason.

SOURCE: CDC/NCHS, National Health Interview Survey, 2012.

Private

Medicaid

Uninsured

All

Percent
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Summary

During 2012, children with Medicaid were more likely to have had at least one ER visit compared 

with children with private insurance or uninsured children. Approximately 75% of children’s most 

recent ER visits were at night or on the weekend, and this percentage was similar regardless of 

health insurance coverage status. Approximately two-thirds of children’s most recent visits to the 

ER were due to reasons that reflected the seriousness of the medical problem, and this differed by 

health insurance coverage status. Children with Medicaid were less likely to visit the ER because 

of reasons reflecting the seriousness of the medical problem and more likely to visit for other 

reasons. Similar to adults aged 18–64, common reasons for children’s most recent ER visits were 

because “only a hospital could help” and the “doctor’s office [was] not open” (5). Some reasons 

for ER visits (e.g., “no other place to go” and “doctor’s office [was] not open”) may depend on 

whether a child has a regular source of care, an association seen previously among adults (5). 

Recent changes to children’s health insurance coverage make it important to monitor the rates, 

timing, and reasons for ER use by health insurance coverage status.

Definitions

Emergency room visit: Based on the response provided to the question “During the past 12 

months, how many times has [sample child] gone to a hospital emergency room about [his/her] 

health? (This includes emergency room visits that resulted in a hospital admission.)”

Health insurance coverage: The “private insurance coverage” category includes children who had 

any comprehensive private insurance plan (including health maintenance and preferred provider 

organizations). These plans include those obtained through an employer, purchased directly, or 

purchased through local or community programs. Private coverage excludes plans that pay for 

only one type of service, such as accidents or dental care. The “Medicaid” category includes 

children without private insurance who reported Medicaid, Children’s Health Insurance Program 

(CHIP), and other state-sponsored health plans. Children were defined as uninsured if they did 

not have any private insurance, Medicare, Medicaid, CHIP, state-sponsored or other governmentsponsored health plan, or military plan at the time of interview. Children also were defined as 

uninsured if they had only Indian Health Service coverage or had only a private plan that paid for 

one type of service, such as accidents or dental care. 

Reasons for last emergency room visit: Respondents who indicated that the sample child had 

visited the emergency room at least once in the past 12 months were then asked, “Tell me which 

of these apply to [sample child’s] last emergency room visit? ‘you didn’t have another place to 

go,’ ‘your doctor’s office or clinic was not open,’ ‘your health provider advised you to go,’ ‘the 

problem was too serious for the doctor’s office or clinic,’ ‘only a hospital could help you,’ ‘the 

emergency room is your closest provider,’ ‘you get most of your care at the emergency room,’ 

‘you arrived by ambulance or other emergency vehicle.’” Respondents could select more than 

one reason, and reasons were not mutually exclusive. Three mutually exclusive categories of 

reasons for last ER visit were developed: children who went to the ER due to reasons reflecting 

the seriousness of medical problem, those who went for reasons other than the seriousness of the 

medical problem, and those who did not select any of the reasons listed.

“Seriousness of medical problem” is a summary based on positive responses to any of the 

following: “your health provider advised you to go,” “the problem was too serious for the 
NCHS Data Brief ■ No. 160 ■ July 2014

■  7  ■

doctor’s office or clinic,” “only a hospital could help you,” or “you arrived by ambulance or 

other emergency vehicle.” Among children who did not attend the ER for a reason reflecting the 

seriousness of the medical problem, “Other reason” is a summary based on positive responses to 

any of the following: “you didn’t have another place to go,” “your doctor’s office or clinic was 

not open,” “the emergency room is your closest provider,” or “you get most of your care at the 

emergency room.”

Timing of last emergency room visit: Based on the response provided to the question “Thinking 

about [sample child’s] most recent emergency room visit, did [he/she] go to the emergency room 

either at night or on the weekend?”

Data source and methods

The National Health Interview Survey (NHIS) is a multipurpose health survey conducted 

continuously throughout the year by the Centers for Disease Control and Prevention’s (CDC) 

National Center for Health Statistics (NCHS). Interviews are conducted in respondents’ homes, 

but follow-ups to complete interviews may be conducted over the telephone. A sample child 

is randomly selected from each family in NHIS, and information about the sample child is 

obtained from an adult residing in the household who is knowledgeable about the child’s health 

(usually the parent). Questions about children’s ER use are from the Sample Child Core and 

Supplemental components of the survey. Questions about health insurance are from the Family 

Core component. Information was collected for 13,275 children.

Survey design and weighting procedures are described in more detail elsewhere (6). To account 

for the complex sample design of NHIS, point estimates and significance tests (using p < 0.05) 

were calculated using SUDAAN software, version 11.0.0 (RTI International, Research Triangle 

Park, N.C.). The Taylor series linearization method was chosen for variance estimation. All 

estimates shown in this report meet the NCHS standard of reliability (relative standard error less 

than or equal to 30%) unless otherwise noted. For further information about NHIS, including the 

questionnaire, visit the NHIS website: http://www.cdc.gov/nchs/nhis.htm.

About the authors

Renee M. Gindi and Lindsey I. Jones are with CDC’s National Center for Health Statistics, 

Division of Health Interview Statistics.
NCHS Data Brief ■ No. 160 ■ July 2014

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References

1. National Center for Health Statistics. Health, United States, 2012: With 

special feature on emergency care. Hyattsville, MD. 2013.

2. Bloom B, Jones LI, Freeman G. Summary health statistics for U.S. 

children: National Health Interview Survey, 2012. National Center for Health 

Statistics. Vital Health Stat 10(258). 2013.

3. Machlin SR. Expenses for a hospital emergency room visit, 2003. 

Rockville, MD: Agency for Healthcare Research and Quality. 2006.

4. Pachter LM, Ludwig S, Groves A. Night people: Utilization of a 

pediatric emergency department during the late night. Pediatr Emerg Care 

7(1):12–4. 1991.

5. Gindi RM, Cohen RA, Kirzinger WK. Emergency room use among 

adults aged 18–64: Early release of estimates from the National Health 

Interview Survey, January–June 2011. National Center for Health Statistics. 

2012.

6. Parsons VL, Moriarity CL, Jonas K, et al. Design and estimation for the 

National Health Interview Survey, 2006–2015. National Center for Health 

Statistics. Vital Health Stat 2(165). 2014.

National Center for Health 

Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health Interview 

Statistics

Jane F. Gentleman, Ph.D., Director

Suggested citation

Gindi RM, Jones LI. Reasons for emergency 

room use among U.S. children: National 

Health Interview Survey, 2012. NCHS data 

brief, no 160. Hyattsville, MD: National 

Center for Health Statistics. 2014.