TABLE E-1 ED Visits by 20 Leading Diagnoses

Principal Reason for Visit

Percent

Contusion with intact skin surface

4.2

Acute upper respiratory infections, excluding pharyngitis

4.0

Abdominal pain

3.9

Chest pain

3.7

Open wound, excluding head

3.6

Spinal disorders

2.5

Otitis media and eustachian tube disorders

2.3

Sprains and strains, excluding neck and back

2.2

Fractures, excluding lower limb

2.1

Open wound of head

2.0

Sprains and strains of neck and ankle and back

2.0

Acute pharyngitis

1.7

Urinary tract infection

1.6

Chronic and unspecified bronchitis

1.6

Superficial injuries

1.6

Cellulitis and abscess

1.6

Pyrexia of unknown origin

1.5

Asthma

1.5

Heart disease, excluding ischemic

1.5

Rheumatism, excluding back

1.5

All other

53.1

Total

99.7

SOURCE: McCaig and Burt, 2005.

1999 and 2003, trauma visits rose by 18.1 percent. Most of this increase reflects patients who were seen by the trauma team and released rather than admitted as patients. The authors suggest that overtriage, perhaps related to malpractice and Emergency Medical Treatment and Active Labor Act (EMTALA) concerns associated with treating injured patients at nontrauma centers, may be a major factor.

Over the past several years, increasingly complex cases have been seen in the ED. Patients are presenting with higher severity of illness, and many have comorbidities and chronic diseases (Derlet and Richards, 2000; Bazzoli et al., 2003). These patients require more complex and time-consuming workups and treatments.

In 2000, 45.4 percent of Americans had a chronic condition (see Figure E-1). That number is expected to grow to 47.7 percent by 2015 (Partnership for Solutions, 2002). Specifically, the prevalence of cardiovascular disease (CVD) will increase by 18 percent as a result of the aging of the population. In 2003, 71 million Americans had CVD (AHA, 2006); by 2010, it is projected that 69 million Americans will have the disease. Simi-



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